Provider Demographics
NPI:1982131595
Name:HEWETT, NICOLE KRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:KRISTINE
Last Name:HEWETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:KRISTINE
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1455 W 2200 S STE 300
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-7219
Mailing Address - Country:US
Mailing Address - Phone:801-412-6920
Mailing Address - Fax:877-497-4661
Practice Address - Street 1:4745 S 3200 W
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2822
Practice Address - Country:US
Practice Address - Phone:801-964-6214
Practice Address - Fax:877-497-4661
Is Sole Proprietor?:No
Enumeration Date:2017-05-12
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13944363-1205208000000X
FLME150803208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics