Basic Information
| Provider Information | |||||||||
| NPI: | 1215441308 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEWSOME | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | LOU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1251 CLARK ST | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437259612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404390733 | ||||||||
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| Practice Location | |||||||||
| Address1: | 61353 SOUTHGATE RD | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437256607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404358585 | ||||||||
| FaxNumber: | 7404352959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2017 | ||||||||
| LastUpdateDate: | 07/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN.CNP.022015 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | APRN.CNP.022015 | 01 | CERTIFIED NURSE PRACTITIONER | OTHER |