Healthcare Provider Details

I. General information

NPI: 1053852947
Provider Name (Legal Business Name): CHARISSA DIANE NEWTON CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 S MASON MONTGOMERY RD SUITE 201
MASON OH
45040-7802
US

IV. Provider business mailing address

7450 S MASON MONTGOMERY RD SUITE 201
MASON OH
45040-7802
US

V. Phone/Fax

Practice location:
  • Phone: 513-770-2797
  • Fax:
Mailing address:
  • Phone: 513-770-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAPRN.CNM.019322
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: