Provider Demographics
NPI:1639837156
Name:HEWES, ALICE AMELIA BROWNE (NP-C)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:AMELIA BROWNE
Last Name:HEWES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2518 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4819
Mailing Address - Country:US
Mailing Address - Phone:208-484-1204
Mailing Address - Fax:
Practice Address - Street 1:2518 W MADISON AVE
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4819
Practice Address - Country:US
Practice Address - Phone:208-484-1204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID69428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily