Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 200350081NP | OR |
NPI | 1063433365 |
---|---|
Provider Name | Thomas S Stewart |
First Address | Portland, OR 97230-6668 |
Second Address | Portland, OR 97230-6668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 12/03/2015 |