Provider Demographics
NPI:1093244139
Name:NEWTON, HALEY (NP-C)
Entity type:Individual
Prefix:MS
First Name:HALEY
Middle Name:
Last Name:NEWTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MRS
Other - First Name:HALEY
Other - Middle Name:NEWTON
Other - Last Name:HENDRICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1214 E NATIONAL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BRAZIL
Mailing Address - State:IN
Mailing Address - Zip Code:47834-2700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1214 E NATIONAL AVE STE 100
Practice Address - Street 2:
Practice Address - City:BRAZIL
Practice Address - State:IN
Practice Address - Zip Code:47834-2700
Practice Address - Country:US
Practice Address - Phone:812-442-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-11
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007157A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
35-1747218OtherTAX ID