Provider Demographics
NPI:1407571532
Name:NEWTON, KRISTIN DIANE (RN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DIANE
Last Name:NEWTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:DIANE
Other - Last Name:MOULTROUP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:11335 S 204TH ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-7871
Mailing Address - Country:US
Mailing Address - Phone:402-332-3936
Mailing Address - Fax:
Practice Address - Street 1:11335 S 204TH ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-7871
Practice Address - Country:US
Practice Address - Phone:402-332-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE67914163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool