Provider Demographics
NPI:1174952741
Name:STEWART, CAROL ELAINE (FNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:ELAINE
Last Name:STEWART
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ELAINE
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:2051 EVERGREEN LN
Mailing Address - Street 2:STE D
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7928
Mailing Address - Country:US
Mailing Address - Phone:928-940-0809
Mailing Address - Fax:
Practice Address - Street 1:12 N WOODLAND RD
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:AZ
Practice Address - Zip Code:85929-6563
Practice Address - Country:US
Practice Address - Phone:928-940-0809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP5196363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care