Provider Demographics
NPI:1255904298
Name:STEWART, CHERYL ELLEN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ELLEN
Last Name:STEWART
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 W PLACITA DEL LOBO
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-1008
Mailing Address - Country:US
Mailing Address - Phone:520-256-1562
Mailing Address - Fax:
Practice Address - Street 1:1830 W PLACITA DEL LOBO
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-1008
Practice Address - Country:US
Practice Address - Phone:520-256-1562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ258978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty