Basic Information
Provider Information | |||||||||
NPI: | 1841766581 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NEWSOM | ||||||||
FirstName: | CRISTINA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PMHNP-BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | NEWSOM | ||||||||
OtherFirstName: | TINA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PMHNP-BC | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 727 | ||||||||
Address2: |   | ||||||||
City: | WATERVILLE | ||||||||
State: | ME | ||||||||
PostalCode: | 049030727 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2076609926 | ||||||||
FaxNumber: | 2076609901 | ||||||||
Practice Location | |||||||||
Address1: | 25 DEPOT ST | ||||||||
Address2: |   | ||||||||
City: | KINGFIELD | ||||||||
State: | ME | ||||||||
PostalCode: | 049474208 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2072654555 | ||||||||
FaxNumber: | 2072655004 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/21/2018 | ||||||||
LastUpdateDate: | 01/24/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/24/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | AP139410 | TX | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LP0808X | CNP201519 | ME | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.