Healthcare Provider Details

I. General information

NPI: 1306458013
Provider Name (Legal Business Name): ACACIA LOUISE NEWCOMB NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

18604 W GEIER RD
GURNEE IL
60031-1365
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-6820
  • Fax: 414-266-6979
Mailing address:
  • Phone: 847-345-5137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number209.030933
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number1024933
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: