Provider Demographics
NPI:1063027282
Name:NEWHOUSE, DELTA CAROL
Entity Type:Individual
Prefix:
First Name:DELTA
Middle Name:CAROL
Last Name:NEWHOUSE
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 1:2380 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1847
Mailing Address - Country:US
Mailing Address - Phone:731-285-1794
Mailing Address - Fax:731-285-1795
Practice Address - Street 1:2380 HENRY ST
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1847
Practice Address - Country:US
Practice Address - Phone:731-285-1794
Practice Address - Fax:731-285-1795
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator