Provider Demographics
NPI:1740949619
Name:HEWITT, JODENE (RN)
Entity type:Individual
Prefix:
First Name:JODENE
Middle Name:
Last Name:HEWITT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3155
Mailing Address - Country:US
Mailing Address - Phone:920-960-2943
Mailing Address - Fax:
Practice Address - Street 1:N7720 COUNTY ROAD WH
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54937-9478
Practice Address - Country:US
Practice Address - Phone:920-960-1793
Practice Address - Fax:920-926-2722
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI179048-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse