Provider Demographics
NPI:1134225204
Name:STEWART, STEPHEN S (CRNA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:STEWART
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 708342
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-8342
Mailing Address - Country:US
Mailing Address - Phone:801-641-1597
Mailing Address - Fax:
Practice Address - Street 1:10011 CENTENNIAL PKWY
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-4156
Practice Address - Country:US
Practice Address - Phone:801-993-9527
Practice Address - Fax:801-733-5872
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4957840-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT107012146101OtherIHC
UT2000033OtherUNITED HEALTHCARE
UTPRA07032OtherMOLINA
UT841401924STEOtherEDUCATORS MUTUAL
UT49578404400001OtherBCBS
UT740580OtherDESERET MUTUAL
UTQM0000055933OtherALTIUS
UT841401924OtherPHCS
UT005586309Medicare ID - Type Unspecified
UT841401924STEOtherEDUCATORS MUTUAL
UT49578404400001OtherBCBS