MEDICARE: MS. ELISABETH DRAKE NEWMAN

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	171W00000X	Contractor	5765	AZ

General Provider Information

NPI Number	:	1558426320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELISABETH DRAKE NEWMAN

Provider Business Mailing Address
First Line	:	2863 E GLENCOVE ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213
Country	:	US
Telephone Number	:	480-588-6766
Fax Number	:

Provider Business Practice Location Address
First Line	:	2863 E GLENCOVE ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213
Country	:	US
Telephone Number	:	480-588-6766
Fax Number	:

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

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	07/18/2007

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