Healthcare Provider Details

I. General information

NPI: 1598715369
Provider Name (Legal Business Name): LOU ANN NEWBY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W10020 OLSON RD
POYNETTE WI
53955-9441
US

IV. Provider business mailing address

W10020 OLSON RD
POYNETTE WI
53955-9441
US

V. Phone/Fax

Practice location:
  • Phone: 608-635-4923
  • Fax:
Mailing address:
  • Phone: 608-635-4923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number StateWI

VIII. Authorized Official

Name: MS. LOU ANN NEWBY
Title or Position: REGISTERED NURSE
Credential:
Phone: 608-635-4923