Healthcare Provider Details

I. General information

NPI: 1952483646
Provider Name (Legal Business Name): CARLA NEWTON R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S LOCUST ST
CENTRALIA IL
62801-3506
US

IV. Provider business mailing address

402 LEAFLAND AVE
CENTRALIA IL
62801-4319
US

V. Phone/Fax

Practice location:
  • Phone: 618-533-1391
  • Fax: 618-533-0012
Mailing address:
  • Phone: 618-322-2399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: