MEDICARE: ELIZABETH ANNE HEWETT CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	655911	TX

General Provider Information

NPI Number	:	1134120587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANNE HEWETT CRNA

Provider Business Mailing Address
First Line	:	1400W 4TH ST
Second Line	:
City	:	COFFEYVILLE
State	:	KS
Zip	:	67337-3306
Country	:	US
Telephone Number	:	620-252-1621
Fax Number	:	785-738-9503

Provider Business Practice Location Address
First Line	:	473 ALAMO RD
Second Line	:
City	:	CAMERON
State	:	TX
Zip	:	76520-3493
Country	:	US
Telephone Number	:	254-541-4254
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/30/2015

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