Healthcare Provider Details

I. General information

NPI: 1285552778
Provider Name (Legal Business Name): AMYRE NEWBERN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10415 W WARREN AVE
DEARBORN MI
48126-1660
US

IV. Provider business mailing address

3700 RESERVOIR RD NW
WASHINGTON DC
20007-2111
US

V. Phone/Fax

Practice location:
  • Phone: 313-878-2845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704397774
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: