Provider Demographics
NPI:1346576089
Name:NEWSOM, HELEN (NP)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 S MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-2705
Mailing Address - Country:US
Mailing Address - Phone:909-384-4495
Mailing Address - Fax:
Practice Address - Street 1:701 S MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-2705
Practice Address - Country:US
Practice Address - Phone:909-384-4495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-31
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA262570363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner