Healthcare Provider Details

I. General information

NPI: 1801130695
Provider Name (Legal Business Name): NICHOLAS R NEWHOUSE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 N STATE ST
SAINT IGNACE MI
49781-1013
US

IV. Provider business mailing address

506 N RAVINE ST
SAULT SAINTE MARIE MI
49783-1732
US

V. Phone/Fax

Practice location:
  • Phone: 906-643-8585
  • Fax:
Mailing address:
  • Phone: 850-238-1021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-110539
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704317294
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: