Provider Demographics
NPI:1477050789
Name:NEWSUM, AUDREY MARGARITA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MISS
First Name:AUDREY
Middle Name:MARGARITA
Last Name:NEWSUM
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:SIGNAL HILL
Mailing Address - State:CA
Mailing Address - Zip Code:90755-3721
Mailing Address - Country:US
Mailing Address - Phone:562-972-6690
Mailing Address - Fax:
Practice Address - Street 1:2218 ROSE AVE
Practice Address - Street 2:
Practice Address - City:SIGNAL HILL
Practice Address - State:CA
Practice Address - Zip Code:90755-3721
Practice Address - Country:US
Practice Address - Phone:562-972-6690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008841363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care