Provider Demographics
NPI:1093279580
Name:HEWITT, ELISA (RN)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:
Last Name:HEWITT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ELISA
Other - Middle Name:
Other - Last Name:OBALLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2901 N GAYLORD ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80205-4625
Mailing Address - Country:US
Mailing Address - Phone:303-319-1779
Mailing Address - Fax:
Practice Address - Street 1:2901 N GAYLORD ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80205-4625
Practice Address - Country:US
Practice Address - Phone:303-319-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-29
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0100868163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse