Provider Demographics
NPI:1760230452
Name:STEWART, ABIGAIL JEAN BRINDUSA (PA-C)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:JEAN BRINDUSA
Last Name:STEWART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4137 LATHROP AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-4911
Mailing Address - Country:US
Mailing Address - Phone:262-664-3055
Mailing Address - Fax:
Practice Address - Street 1:4328 OLD GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53403-9489
Practice Address - Country:US
Practice Address - Phone:262-687-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7866-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant