Individual
MARISSA ANN HEWITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
630 MEDICAL DR, BOUNTIFUL, UT 84010-4908
(801) 299-2276
Mailing address
1586 E MILLBROOK WAY, BOUNTIFUL, UT 84010-1530
(801) 298-3220
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
309002-4406
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30900244000001
BLUE CROSS
UT
05
—
529910998001
—
UT
Enumeration date
01/19/2007
Last updated
07/08/2007
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