Provider Demographics
NPI:1689204976
Name:HEWITT, CECILY (CNA CERTIFICATE)
Entity Type:Individual
Prefix:
First Name:CECILY
Middle Name:
Last Name:HEWITT
Suffix:
Gender:F
Credentials:CNA CERTIFICATE
Other - Prefix:
Other - First Name:CECILY
Other - Middle Name:MICHELLE
Other - Last Name:HEWITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNA CERTIFICATE
Mailing Address - Street 1:4700 S LAKE PARK AVE APT 501
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-7011
Mailing Address - Country:US
Mailing Address - Phone:773-322-5555
Mailing Address - Fax:773-981-0077
Practice Address - Street 1:4700 S LAKE PARK AVE APT 501
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-7011
Practice Address - Country:US
Practice Address - Phone:773-322-5555
Practice Address - Fax:773-981-0077
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL000000000000OtherSTATE