Basic Information
Provider Information | |||||||||
NPI: | 1225208267 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NEWLANDS | ||||||||
FirstName: | JOANNA | ||||||||
MiddleName: | LEE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | LPN/CF-M | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 180 ACADEMY ST | ||||||||
Address2: | SUITE 5 | ||||||||
City: | PRESQUE ISLE | ||||||||
State: | ME | ||||||||
PostalCode: | 047693183 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2077647200 | ||||||||
FaxNumber: | 2077647204 | ||||||||
Practice Location | |||||||||
Address1: | 180 ACADEMY ST | ||||||||
Address2: | SUITE 5 | ||||||||
City: | PRESQUE ISLE | ||||||||
State: | ME | ||||||||
PostalCode: | 047693183 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2077647200 | ||||||||
FaxNumber: | 2077647204 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/05/2008 | ||||||||
LastUpdateDate: | 06/05/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | P011527 | ME | Y |   | Nursing Service Providers | Licensed Practical Nurse |   | 1744P3200X | ABC CERT CFM01831 |   | N |   | Other Service Providers | Specialist | Prosthetics Case Management |
No ID Information.