Provider Demographics
NPI:1215536099
Name:NEWBROUGH, RADONNA LYNNE
Entity Type:Individual
Prefix:
First Name:RADONNA
Middle Name:LYNNE
Last Name:NEWBROUGH
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 1:533 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:PADEN CITY
Mailing Address - State:WV
Mailing Address - Zip Code:26159-1219
Mailing Address - Country:US
Mailing Address - Phone:304-337-9230
Mailing Address - Fax:304-337-9236
Practice Address - Street 1:533 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:PADEN CITY
Practice Address - State:WV
Practice Address - Zip Code:26159-1219
Practice Address - Country:US
Practice Address - Phone:304-337-9230
Practice Address - Fax:304-337-9236
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator