1174897557 NPI number — MRS. MISHAUN FRANCES NEWMAN FNP-C

Table of content: DR. BRIAN KEITH NICHOLS O.D. (NPI 1700840840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174897557 NPI number — MRS. MISHAUN FRANCES NEWMAN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWMAN
Provider First Name:
MISHAUN
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174897557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2865 GRANDHILL RD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BULLHEAD CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86442-8512
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-339-7688
Provider Business Mailing Address Fax Number:
928-444-1445

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3640 HWY 95 SUITE 100 BULLHEAD CITY AZ 86442
Provider Second Line Business Practice Location Address:
3640 HWY 95 SUITE 100 BULLHEAD CITY AZ 86442
Provider Business Practice Location Address City Name:
BULLHEAD CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86442-8199
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-224-5557
Provider Business Practice Location Address Fax Number:
928-224-5558
Provider Enumeration Date:
03/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP4380 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com