Provider Demographics
NPI:1134140064
Name:NEWELL, JUDITH ANNE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:NEWELL
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:ANNE
Other - Last Name:HELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5151 E BROADWAY RD STE 107
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1346
Mailing Address - Country:US
Mailing Address - Phone:480-290-7000
Mailing Address - Fax:602-254-6840
Practice Address - Street 1:5151 E BROADWAY RD STE 107
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1346
Practice Address - Country:US
Practice Address - Phone:480-290-7000
Practice Address - Fax:480-325-3461
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN067066163WG0000X
AZAP0391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ313552Medicaid
AZAP0391OtherLICENSE