Basic Information
Provider Information | |||||||||
NPI: | 1053365726 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NEWLANDER | ||||||||
FirstName: | THOMAS | ||||||||
MiddleName: | RAYMOND | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNA | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 5040 | ||||||||
Address2: |   | ||||||||
City: | OROVILLE | ||||||||
State: | CA | ||||||||
PostalCode: | 95966 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5305328584 | ||||||||
FaxNumber: | 5305328433 | ||||||||
Practice Location | |||||||||
Address1: | 2767 OLIVE HIGHWAY | ||||||||
Address2: |   | ||||||||
City: | OROVILLE | ||||||||
State: | CA | ||||||||
PostalCode: | 95966 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5305338500 | ||||||||
FaxNumber: | 5305328433 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/19/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN247916 | CA | X |   | Nursing Service Providers | Registered Nurse |   | 367500000X | 921 | CA | X |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |   |
ID Information
ID | Type | State | Issuer | Description | P00158302 | 01 |   | RAILROAD MEDICARE RRM | OTHER | RN2479160 | 05 | CA |   | MEDICAID |