Provider Demographics
NPI:1740303353
Name:HEWITT, LISA KRISTINE (RN BSN)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:KRISTINE
Last Name:HEWITT
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SOUTH CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:NY
Mailing Address - Zip Code:14530
Mailing Address - Country:US
Mailing Address - Phone:585-237-6506
Mailing Address - Fax:
Practice Address - Street 1:36 SOUTH CENTER ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:NY
Practice Address - Zip Code:14530
Practice Address - Country:US
Practice Address - Phone:585-237-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4926571163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02637272Medicaid