Provider Demographics
NPI:1871550699
Name:HEWSON, PATRICIA MOUL (CRNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MOUL
Last Name:HEWSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 MARKET STREET
Mailing Address - Street 2:LM 500 WEST TOWER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2100
Mailing Address - Country:US
Mailing Address - Phone:215-985-2595
Mailing Address - Fax:
Practice Address - Street 1:1900 N 9TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19122-1909
Practice Address - Country:US
Practice Address - Phone:215-765-6690
Practice Address - Fax:215-765-6694
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAVP000992D363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1488053OtherAETNA
PA1590248OtherBLUE CROSS
PA2268264000OtherKEYSTONE HEALTH PLAN EAST
PA0016148630001Medicaid
PA30027023OtherKEYSTONE MERCY HEALTH PLAN
PA0016148630001Medicaid