Provider Demographics
NPI:1518422567
Name:JEWETT, CHRIS ANNE (NP)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:ANNE
Last Name:JEWETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 STATE HIGHWAY 37
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:NY
Mailing Address - Zip Code:13646-3282
Mailing Address - Country:US
Mailing Address - Phone:315-523-4553
Mailing Address - Fax:
Practice Address - Street 1:826 WASHINGTON ST STE 106
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4071
Practice Address - Country:US
Practice Address - Phone:315-755-3083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF3439481363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner