Healthcare Provider Details

I. General information

NPI: 1114256963
Provider Name (Legal Business Name): ELIZABETH CICELY NEWSOME NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LIBBY NEWSOME NP

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 GINGERLY LN
GREENSBORO NC
27455-2886
US

IV. Provider business mailing address

22 GINGERLY LN
GREENSBORO NC
27455-2886
US

V. Phone/Fax

Practice location:
  • Phone: 336-562-8424
  • Fax: 833-993-3475
Mailing address:
  • Phone: 336-456-2842
  • Fax: 833-993-4967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number800081
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number38487
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: