Basic Information
Provider Information
NPI: 1154751881
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEWTON
FirstName: REGINA
MiddleName: MARIA
NamePrefix:  
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 896206
Address2:  
City: CHARLOTTE
State: NC
PostalCode: 282896206
CountryCode: US
TelephoneNumber: 2526336730
FaxNumber: 2526336740
Practice Location
Address1: 4252 ARENDELL ST
Address2: SUITE E
City: MOREHEAD CITY
State: NC
PostalCode: 285570010
CountryCode: US
TelephoneNumber: 2528080145
FaxNumber: 2528082770
Other Information
ProviderEnumerationDate: 11/15/2013
LastUpdateDate: 03/17/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2200X5006592NCY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health

No ID Information.


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