Healthcare Provider Details

I. General information

NPI: 1801700661
Provider Name (Legal Business Name): MIA AYANNA NEWKIRK RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST BLVD
ELKHART IN
46514-2499
US

IV. Provider business mailing address

1301 BEACON CT
MISHAWAKA IN
46544-6239
US

V. Phone/Fax

Practice location:
  • Phone: 574-294-2621
  • Fax:
Mailing address:
  • Phone: 574-347-5067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number28274281A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: