Provider Demographics
NPI:1114635588
Name:NEWSOME, CARRIE A (RN, CNS)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1636 RIVERCREST LN
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1418
Mailing Address - Country:US
Mailing Address - Phone:908-328-1741
Mailing Address - Fax:
Practice Address - Street 1:1636 RIVERCREST LN
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1418
Practice Address - Country:US
Practice Address - Phone:908-328-1741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist