Provider Demographics
NPI:1194846576
Name:NEWBERRY, KASTONIA M
Entity Type:Individual
Prefix:
First Name:KASTONIA
Middle Name:M
Last Name:NEWBERRY
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 1:1600 E MAIN ST
Mailing Address - Street 2:PO BOX 369
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122
Mailing Address - Country:US
Mailing Address - Phone:317-745-7066
Mailing Address - Fax:317-745-0663
Practice Address - Street 1:1600 E MAIN ST
Practice Address - Street 2:BOX 369 (PO)
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122
Practice Address - Country:US
Practice Address - Phone:317-745-7066
Practice Address - Fax:317-745-0663
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist