Provider Demographics
NPI:1154544310
Name:NEWMAN, JOANNA
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5825 BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2687
Mailing Address - Country:US
Mailing Address - Phone:219-981-9000
Mailing Address - Fax:219-981-9510
Practice Address - Street 1:5825 BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2687
Practice Address - Country:US
Practice Address - Phone:219-981-9000
Practice Address - Fax:219-981-9510
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029392363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner