Provider Demographics
NPI:1639347735
Name:HEWITT, LA CREZIA (LVN)
Entity Type:Individual
Prefix:
First Name:LA CREZIA
Middle Name:
Last Name:HEWITT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2877
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-0054
Mailing Address - Country:US
Mailing Address - Phone:909-938-2014
Mailing Address - Fax:
Practice Address - Street 1:8077 TUSCANY ST
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-3859
Practice Address - Country:US
Practice Address - Phone:909-938-2014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN197233164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse