Healthcare Provider Details

I. General information

NPI: 1508394776
Provider Name (Legal Business Name): MS. BAYLEE NICOLE NEWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 05/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF MAINE
ORONO ME
04469-0001
US

IV. Provider business mailing address

542 HOSMER ST
MARLBOROUGH MA
01752-1498
US

V. Phone/Fax

Practice location:
  • Phone: 508-510-9185
  • Fax:
Mailing address:
  • Phone: 508-510-9185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: