Basic Information
| Provider Information | |||||||||
| NPI: | 1649757352 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEWLAND | ||||||||
| FirstName: | BRITTANY | ||||||||
| MiddleName: | |||||||||
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| Credential: | B.S., HAD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5350 E BROADWAY BLVD STE 108 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857113722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207909779 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5350 E BROADWAY BLVD STE 108 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857113722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5207909779 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2018 | ||||||||
| LastUpdateDate: | 07/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | HADE10080 | AZ | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
ID Information
| ID | Type | State | Issuer | Description | HADE10080 | 01 | AZ | STATE OF ARIZONA | OTHER |