Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | MI |
NPI | 1174106579 |
---|---|
Provider Name | Deyonta Newsome |
First Address | Detroit, MI 48234-2358 |
Second Address | Detroit, MI 48234-2358 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2021 |
Last Update Date | 06/10/2021 |