Provider Demographics
NPI:1164240164
Name:HEWSTON, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HEWSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23900 CHAGRIN BLVD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5511
Mailing Address - Country:US
Mailing Address - Phone:216-464-1000
Mailing Address - Fax:216-591-9244
Practice Address - Street 1:4675 E 153RD ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-3014
Practice Address - Country:US
Practice Address - Phone:216-358-8548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH363816391189376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide