Healthcare Provider Details

I. General information

NPI: 1033524210
Provider Name (Legal Business Name): GENEVA E HEWITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GENEVA EBOW

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 COPPER MOON LN
NORTH LAS VEGAS NV
89031-1908
US

IV. Provider business mailing address

PO BOX 34831
LAS VEGAS NV
89133-4831
US

V. Phone/Fax

Practice location:
  • Phone: 707-761-6268
  • Fax: 702-359-0674
Mailing address:
  • Phone: 707-761-6268
  • Fax: 702-359-0674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: