Healthcare Provider Details

I. General information

NPI: 1013663640
Provider Name (Legal Business Name): NANNETTE NEWTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2022
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16415 N 168TH AVE
SURPRISE AZ
85388-1330
US

IV. Provider business mailing address

2025 N 3RD ST STE 300
PHOENIX AZ
85004-1486
US

V. Phone/Fax

Practice location:
  • Phone: 520-582-7396
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License NumberBH7304
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberBH7304
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: