MEDICARE: MS. EMMALINE CAMILLE NEWMAN APRN

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	363L00000X	Nurse Practitioner	11783163	TN

General Provider Information

NPI Number	:	1740839315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMMALINE CAMILLE NEWMAN APRN

Provider Business Mailing Address
First Line	:	1703 W 54TH ST
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37409-2011
Country	:	US
Telephone Number	:	307-371-5520
Fax Number	:

Provider Business Practice Location Address
First Line	:	1703 W 54TH ST
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37409-2011
Country	:	US
Telephone Number	:	307-371-5520
Fax Number	:

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

Provider Enumeration Date	:	09/06/2019
Last Update Date	:	09/06/2019

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