Provider Demographics
NPI:1235726753
Name:HEWITT, JOHANNA CHRISTINE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:CHRISTINE
Last Name:HEWITT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:JODI
Other - Middle Name:CHRISTINE
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:532 SIMONSON ST
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53531-9333
Mailing Address - Country:US
Mailing Address - Phone:608-712-9425
Mailing Address - Fax:
Practice Address - Street 1:1 HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770-9998
Practice Address - Country:US
Practice Address - Phone:605-867-5131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2019095815363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily