Provider Demographics
NPI:1598513772
Name:NEWTON, MADISON PORTER (PA-S)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:PORTER
Last Name:NEWTON
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 NOVELL PL
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-6171
Mailing Address - Country:US
Mailing Address - Phone:970-402-6164
Mailing Address - Fax:
Practice Address - Street 1:1800 S NOVELL PLACE
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606
Practice Address - Country:US
Practice Address - Phone:970-402-6164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program