Healthcare Provider Details

I. General information

NPI: 1447892781
Provider Name (Legal Business Name): THERESE MARIE HEWITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 BRIDGE ST
RICHMOND VT
05477-4507
US

IV. Provider business mailing address

17 NORTH RD
WESTFORD VT
05494-9766
US

V. Phone/Fax

Practice location:
  • Phone: 802-777-8938
  • Fax:
Mailing address:
  • Phone: 802-922-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0260020522
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: