Healthcare Provider Details

I. General information

NPI: 1508882226
Provider Name (Legal Business Name): KATHRYN ELAINE NEWBURN CNM, RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 10/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 SUMMERFIELD RD
SANTA ROSA CA
95405-5239
US

IV. Provider business mailing address

1301 SANCHEZ AVE
BURLINGAME CA
94010-3643
US

V. Phone/Fax

Practice location:
  • Phone: 707-539-1544
  • Fax:
Mailing address:
  • Phone: 650-347-0801
  • Fax: 650-347-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number259066
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number259066
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: