Provider Demographics
NPI:1942298773
Name:STEWART, BETTY L (PAC)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:L
Last Name:STEWART
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 CHERRY AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-4229
Mailing Address - Country:US
Mailing Address - Phone:360-598-7500
Mailing Address - Fax:360-598-7505
Practice Address - Street 1:19500 10TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6331
Practice Address - Country:US
Practice Address - Phone:360-598-7500
Practice Address - Fax:360-598-7505
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003764363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant