Provider Demographics
NPI:1285707653
Name:STEWART, MARTHA ANNE (PA)
Entity type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ANNE
Last Name:STEWART
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1665 DOMINICAN WAY
Mailing Address - Street 2:SUITE 222
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1580
Mailing Address - Country:US
Mailing Address - Phone:844-387-5337
Mailing Address - Fax:866-264-3890
Practice Address - Street 1:1665 DOMINICAN WAY
Practice Address - Street 2:SUITE 222
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1580
Practice Address - Country:US
Practice Address - Phone:844-387-5337
Practice Address - Fax:866-264-3890
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52362363A00000X
CA251583363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA147934OtherMEDICARE PTAN