Provider Demographics
NPI:1114256963
Name:NEWSOME, ELIZABETH CICELY (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CICELY
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:
Other - Last Name:NEWSOME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:802 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7041
Mailing Address - Country:US
Mailing Address - Phone:336-273-3661
Mailing Address - Fax:336-273-9438
Practice Address - Street 1:802 GREEN VALLEY RD
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7041
Practice Address - Country:US
Practice Address - Phone:336-273-3661
Practice Address - Fax:336-273-9438
Is Sole Proprietor?:No
Enumeration Date:2009-12-08
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38487363LX0001X
NC800081363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology