Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife |
NPI | 1093288821 |
---|---|
Provider Name | Kristy Newell |
First Address | Talent, OR 97540-7804 |
Second Address | Talent, OR 97540-7804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2019 |
Last Update Date | 03/01/2019 |