Provider Demographics
NPI:1053852947
Name:NEWTON, CHARISSA DIANE (CNM)
Entity Type:Individual
Prefix:
First Name:CHARISSA
Middle Name:DIANE
Last Name:NEWTON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7450 S MASON MONTGOMERY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-7802
Mailing Address - Country:US
Mailing Address - Phone:513-770-2797
Mailing Address - Fax:
Practice Address - Street 1:7450 S MASON MONTGOMERY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7802
Practice Address - Country:US
Practice Address - Phone:513-770-2797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNM.019322367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife