Healthcare Provider Details

I. General information

NPI: 1225548175
Provider Name (Legal Business Name): ERIN JUSTINE HEWITT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 11/10/2021
Certification Date: 10/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 PLYMOUTH RD #D
MINNETONKA MN
55305
US

IV. Provider business mailing address

18330 5TH AVE N
PLYMOUTH MN
55447-3310
US

V. Phone/Fax

Practice location:
  • Phone: 278-461-2963
  • Fax:
Mailing address:
  • Phone: 763-639-0451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95006029
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number95006029
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: