Healthcare Provider Details

I. General information

NPI: 1164411005
Provider Name (Legal Business Name): ANNA NEWLIN CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 BISCAYNE BLVD
MIAMI FL
33137
US

IV. Provider business mailing address

PO BOX 453
ELMWOOD PARK NJ
07407-0453
US

V. Phone/Fax

Practice location:
  • Phone: 312-350-9462
  • Fax:
Mailing address:
  • Phone: 773-764-6192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number246.00018
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: