Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | SP016977 | PA |
NPI | 1053856005 |
---|---|
Provider Name | Stacey Hewitt |
First Address | Reading, PA 19606-9203 |
Second Address | Reading, PA 19606-9203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2016 |
Last Update Date | 29/12/2016 |