Basic Information
| Provider Information | |||||||||
| NPI: | 1871550699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEWSON | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | MOUL | ||||||||
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| Credential: | C.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 MARKET STREET | ||||||||
| Address2: | LM 500 WEST TOWER | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191202100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159852595 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 N 9TH ST | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191221909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157656690 | ||||||||
| FaxNumber: | 2157656694 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 07/14/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | VP000992D | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1488053 | 01 | PA | AETNA | OTHER | 1590248 | 01 | PA | BLUE CROSS | OTHER | 2268264000 | 01 | PA | KEYSTONE HEALTH PLAN EAST | OTHER | 0016148630001 | 05 | PA | MEDICAID | 30027023 | 01 | PA | KEYSTONE MERCY HEALTH PLAN | OTHER |