MEDICARE: RADONNA LYNNE NEWBROUGH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1215536099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RADONNA LYNNE NEWBROUGH

Provider Business Mailing Address
First Line	:	533 S 4TH AVE
Second Line	:
City	:	PADEN CITY
State	:	WV
Zip	:	26159-1219
Country	:	US
Telephone Number	:	304-337-9230
Fax Number	:	304-337-9236

Provider Business Practice Location Address
First Line	:	533 S 4TH AVE
Second Line	:
City	:	PADEN CITY
State	:	WV
Zip	:	26159-1219
Country	:	US
Telephone Number	:	304-337-9230
Fax Number	:	304-337-9236

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2020
Last Update Date	:	11/12/2020

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Directions to “ RADONNA LYNNE NEWBROUGH ” Practice Location

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