Basic Information
| Provider Information | |||||||||
| NPI: | 1194331371 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEWCOMB | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | AMANDA | ||||||||
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| Credential: | PMH-NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 123 N MCCREARY ST | ||||||||
| Address2: | |||||||||
| City: | FORT BRANCH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476481313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8127531039 | ||||||||
| FaxNumber: | 8127531122 | ||||||||
| Practice Location | |||||||||
| Address1: | 123 N MCCREARY ST | ||||||||
| Address2: | |||||||||
| City: | FORT BRANCH | ||||||||
| State: | IN | ||||||||
| PostalCode: | 476481313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8127531039 | ||||||||
| FaxNumber: | 8127531122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/22/2020 | ||||||||
| LastUpdateDate: | 09/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 71010385A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LP0808X | 71010385A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.