Provider Demographics
NPI:1487234910
Name:JEWETT, DEMARCUS
Entity type:Individual
Prefix:MR
First Name:DEMARCUS
Middle Name:
Last Name:JEWETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20846 MAY SHOWERS CIRCLE
Mailing Address - Street 2:APT #5
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095
Mailing Address - Country:US
Mailing Address - Phone:346-954-4608
Mailing Address - Fax:
Practice Address - Street 1:20846 MAY SHOWERS CIRCLE
Practice Address - Street 2:APT #5
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095
Practice Address - Country:US
Practice Address - Phone:346-954-4608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider