Provider Demographics
NPI:1558104281
Name:NEWCOMB, CORYN ANNE
Entity type:Individual
Prefix:
First Name:CORYN
Middle Name:ANNE
Last Name:NEWCOMB
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 1:321 8TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-5927
Mailing Address - Country:US
Mailing Address - Phone:605-290-1180
Mailing Address - Fax:
Practice Address - Street 1:1002 N JAY ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-2439
Practice Address - Country:US
Practice Address - Phone:605-622-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR055075163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology