Healthcare Provider Details

I. General information

NPI: 1447233655
Provider Name (Legal Business Name): JENNIFER MARY NEWMAN CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 N SANDUSKY AVE
UPPER SANDUSKY OH
43351-1098
US

IV. Provider business mailing address

8289 CH 58
UPPER SANDUSKY OH
43351
US

V. Phone/Fax

Practice location:
  • Phone: 419-294-4991
  • Fax: 419-294-2233
Mailing address:
  • Phone: 419-294-3785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberCOA.08405-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: