Provider Demographics
NPI:1851841795
Name:KEIVER-HEWETT, GWENDOLYN (LMT)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:
Last Name:KEIVER-HEWETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RAYMOND TER
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5349
Mailing Address - Country:US
Mailing Address - Phone:781-718-9767
Mailing Address - Fax:
Practice Address - Street 1:120 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-2340
Practice Address - Country:US
Practice Address - Phone:781-718-9767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8980174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist