Provider Demographics
NPI:1245623982
Name:HEWITT, LATRISE (LVN)
Entity type:Individual
Prefix:
First Name:LATRISE
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 1:1110 TENAHA ST
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-3036
Mailing Address - Country:US
Mailing Address - Phone:936-598-6608
Mailing Address - Fax:936-598-6618
Practice Address - Street 1:1110 TENAHA ST
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-3036
Practice Address - Country:US
Practice Address - Phone:936-598-6608
Practice Address - Fax:936-598-6618
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX317312164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse