MEDICARE: MRS. JOHANNA CHRISTINE HEWITT FNP

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	363LF0000X	Family Nurse Practitioner	2019095815	WI

General Provider Information

NPI Number	:	1235726753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOHANNA CHRISTINE HEWITT FNP

Provider Business Mailing Address
First Line	:	532 SIMONSON ST
Second Line	:
City	:	DEERFIELD
State	:	WI
Zip	:	53531-9333
Country	:	US
Telephone Number	:	608-712-9425
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 HIGHWAY 18
Second Line	:
City	:	PINE RIDGE
State	:	SD
Zip	:	57770-9998
Country	:	US
Telephone Number	:	605-867-5131
Fax Number	:

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

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	12/30/2020

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