Healthcare Provider Details

I. General information

NPI: 1023787835
Provider Name (Legal Business Name): LORETTA NEWTON RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 ALLEGHANY RD
CORFU NY
14036-9702
US

IV. Provider business mailing address

PO BOX 308
CORFU NY
14036-0308
US

V. Phone/Fax

Practice location:
  • Phone: 585-599-4525
  • Fax: 585-599-4213
Mailing address:
  • Phone: 585-599-4525
  • Fax: 585-599-4213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number604947
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: