Provider Demographics
NPI:1528392743
Name:HEWITT, SUZANNE H (FNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:H
Last Name:HEWITT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 RIVER DR.
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5403
Mailing Address - Country:US
Mailing Address - Phone:707-961-4631
Mailing Address - Fax:707-961-4631
Practice Address - Street 1:721 RIVER DR.
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5403
Practice Address - Country:US
Practice Address - Phone:707-961-4631
Practice Address - Fax:707-961-4631
Is Sole Proprietor?:No
Enumeration Date:2009-09-21
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX549364363LF0000X
CA21530363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8L19939Medicare UPIN