Provider Demographics
NPI:1497947717
Name:NEWMAN, SHEENA ROUBIQUE (NP)
Entity Type:Individual
Prefix:
First Name:SHEENA
Middle Name:ROUBIQUE
Last Name:NEWMAN
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 1:835 THAMES AVE
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520-5005
Mailing Address - Country:US
Mailing Address - Phone:228-575-2383
Mailing Address - Fax:228-463-0827
Practice Address - Street 1:2101 ROBIN AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-5772
Practice Address - Country:US
Practice Address - Phone:985-318-1000
Practice Address - Fax:985-318-1001
Is Sole Proprietor?:No
Enumeration Date:2007-08-10
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO5313363L00000X
MSR871604363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1023086Medicaid
LA1023086Medicaid