Provider Demographics
NPI:1144699729
Name:IRVING, STEWART (NP)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:
Last Name:IRVING
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 EDWARDS
Mailing Address - Street 2:
Mailing Address - City:WESTCLIFFE
Mailing Address - State:CO
Mailing Address - Zip Code:81252-8588
Mailing Address - Country:US
Mailing Address - Phone:719-783-2380
Mailing Address - Fax:719-783-2377
Practice Address - Street 1:704 EDWARDS
Practice Address - Street 2:
Practice Address - City:WESTCLIFFE
Practice Address - State:CO
Practice Address - Zip Code:81252-8588
Practice Address - Country:US
Practice Address - Phone:719-783-2380
Practice Address - Fax:719-783-2377
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-24
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008002363LF0000X
NC279986363LF0000X
COAPN.0992886-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO64135071Medicaid
NDP01622948OtherRR MEDICARE
NCNCQ186AMedicare PIN
CO536204YKUWMedicare PIN