Provider Demographics
NPI:1114256963
Name:NEWSOME, ELIZABETH CICELY (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CICELY
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:
Other - Last Name:NEWSOME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:22 GINGERLY LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2886
Mailing Address - Country:US
Mailing Address - Phone:336-456-2842
Mailing Address - Fax:833-993-4967
Practice Address - Street 1:22 GINGERLY LN
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2886
Practice Address - Country:US
Practice Address - Phone:336-562-8424
Practice Address - Fax:833-993-3475
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC800081363LW0102X
NC38487363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology