Basic Information
| Provider Information | |||||||||
| NPI: | 1114256963 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEWSOME | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | CICELY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | NEWSOME | ||||||||
| OtherFirstName: | LIBBY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | NP | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 802 GREEN VALLEY RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362733661 | ||||||||
| FaxNumber: | 3362739438 | ||||||||
| Practice Location | |||||||||
| Address1: | 802 GREEN VALLEY RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREENSBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 274087041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362733661 | ||||||||
| FaxNumber: | 3362739438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2009 | ||||||||
| LastUpdateDate: | 01/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | 38487 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
No ID Information.