Provider Demographics
NPI:1265714117
Name:YVONNE M HEWETT
Entity type:Organization
Organization Name:YVONNE M HEWETT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HEWETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-368-6174
Mailing Address - Street 1:1473 CEDAR GROVE RD SW
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-3021
Mailing Address - Country:US
Mailing Address - Phone:910-368-6174
Mailing Address - Fax:
Practice Address - Street 1:1473 CEDAR GROVE RD SW
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-3021
Practice Address - Country:US
Practice Address - Phone:910-368-6174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization