MEDICARE: MALLORY NEWMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10898232-8900	UT
2	363LF0000X	Family Nurse Practitioner	MSLN45738ID	AZ

General Provider Information

NPI Number	:	1013426642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY NEWMAN

Provider Business Mailing Address
First Line	:	2240 S ELKS LN UNIT 10
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-6201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 W BROADWAY STE 300
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84101-2044
Country	:	US
Telephone Number	:	208-244-8085
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2017
Last Update Date	:	10/05/2023

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Directions to “ MALLORY NEWMAN ” Practice Location

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