MEDICARE: MIRIAM S NEW NP

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	363L00000X	Nurse Practitioner	0024164788	VA

General Provider Information

NPI Number	:	1659377612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM S NEW NP

Provider Business Mailing Address
First Line	:	6350 CENTER DR
Second Line	:	SUITE 200
City	:	NORFOLK
State	:	VA
Zip	:	23502
Country	:	US
Telephone Number	:	757-213-5700
Fax Number	:	757-213-5701

Provider Business Practice Location Address
First Line	:	500 SENTARA CIRCLE
Second Line	:	SUITE 203
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23188-5727
Country	:	US
Telephone Number	:	757-873-9400
Fax Number	:	757-213-5701

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	09/28/2017

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