Healthcare Provider Details

I. General information

NPI: 1639552813
Provider Name (Legal Business Name): MRS. MEGHAN NEWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 HOLLY HILL LN
GREENWICH CT
06830-6098
US

IV. Provider business mailing address

40 CROSS ST
NORWALK CT
06851-4647
US

V. Phone/Fax

Practice location:
  • Phone: 203-869-6960
  • Fax: 203-869-5103
Mailing address:
  • Phone: 203-845-2160
  • Fax: 203-663-7978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number006079
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: