Provider Demographics
NPI:1558349134
Name:STEWART, ELIZABETH L (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:STEWART
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:L
Other - Last Name:VITO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:1776 N SCOTTSDALE RD UNIT 368
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85252-3616
Mailing Address - Country:US
Mailing Address - Phone:480-201-5264
Mailing Address - Fax:480-393-1970
Practice Address - Street 1:222 W 8TH ST UNIT 3826
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81302-4852
Practice Address - Country:US
Practice Address - Phone:480-201-5264
Practice Address - Fax:480-393-1970
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008180363AM0700X, 363AS0400X
AZ3304363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ975641Medicaid
Q57668Medicare UPIN
AZ975641Medicaid