Provider Demographics
NPI:1518223643
Name:NEWBURN, ALVIN S II (MHPP)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:S
Last Name:NEWBURN
Suffix:II
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 CARLTON DR
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:AR
Mailing Address - Zip Code:71639-2836
Mailing Address - Country:US
Mailing Address - Phone:870-382-1680
Mailing Address - Fax:870-382-1681
Practice Address - Street 1:105 CARLTON DR
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:AR
Practice Address - Zip Code:71639-2836
Practice Address - Country:US
Practice Address - Phone:870-382-1680
Practice Address - Fax:870-382-1681
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator