Healthcare Provider Details

I. General information

NPI: 1821490590
Provider Name (Legal Business Name): MS. ALICIA ELLEN NEWSOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2014
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 E MAUMEE ST STE 14
ADRIAN MI
49221-2724
US

IV. Provider business mailing address

136 E MAUMEE ST STE 14
ADRIAN MI
49221-2724
US

V. Phone/Fax

Practice location:
  • Phone: 517-605-0751
  • Fax:
Mailing address:
  • Phone: 517-605-0751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number2701130793
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number2701130793
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: