Provider Demographics
NPI:1104174481
Name:HEWITT, JEREMY (DNP, APRN, ACNP-BC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:HEWITT
Suffix:
Gender:M
Credentials:DNP, APRN, ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9136 S COPPERING AVE
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-4682
Mailing Address - Country:US
Mailing Address - Phone:801-651-0011
Mailing Address - Fax:801-280-1836
Practice Address - Street 1:9136 S COPPERING AVE
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-4682
Practice Address - Country:US
Practice Address - Phone:801-651-0011
Practice Address - Fax:801-280-1836
Is Sole Proprietor?:No
Enumeration Date:2012-08-17
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT281822-4405363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care