Provider Demographics
NPI:1205179207
Name:HEWETT, RICHARD BRUCE (RNCST, CNCT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:BRUCE
Last Name:HEWETT
Suffix:
Gender:M
Credentials:RNCST, CNCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-9759
Mailing Address - Country:US
Mailing Address - Phone:704-281-5995
Mailing Address - Fax:
Practice Address - Street 1:609 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-9759
Practice Address - Country:US
Practice Address - Phone:704-281-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC456246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic