Provider Demographics
NPI:1710688577
Name:JEWETT, JAMES W (RN)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:JEWETT
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 PROSPECT ST APT 3
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-1490
Mailing Address - Country:US
Mailing Address - Phone:617-767-7878
Mailing Address - Fax:
Practice Address - Street 1:135 PROSPECT ST APT 3
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-1490
Practice Address - Country:US
Practice Address - Phone:617-767-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-16
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN64824163WP0808X
RICAPRN03893363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health