Healthcare Provider Details

I. General information

NPI: 1447904164
Provider Name (Legal Business Name): CARRIE HEWITT RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 CLARENDON LN
SAINT CHARLES MO
63301-4503
US

IV. Provider business mailing address

324 CLARENDON LN
SAINT CHARLES MO
63301-4503
US

V. Phone/Fax

Practice location:
  • Phone: 636-699-8884
  • Fax:
Mailing address:
  • Phone: 636-699-8884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number2005022469
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: