Provider Demographics
NPI:1588678056
Name:NEWTON, THOMAS LONG JR (LVN)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:LONG
Last Name:NEWTON
Suffix:JR
Gender:M
Credentials:LVN
Other - Prefix:
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Mailing Address - Street 1:4917 U ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1528
Mailing Address - Country:US
Mailing Address - Phone:916-455-4813
Mailing Address - Fax:
Practice Address - Street 1:4600 BROADWAY
Practice Address - Street 2:PRIMARY CARE CENTER
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-1527
Practice Address - Country:US
Practice Address - Phone:916-874-2554
Practice Address - Fax:916-874-9297
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAVN163558164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse