Provider Demographics
NPI:1558961425
Name:NEWSOM, CHRISTIAN REESE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:REESE
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7219 N LITCHFIELD RD BLDG 1130
Mailing Address - Street 2:
Mailing Address - City:LUKE AFB
Mailing Address - State:AZ
Mailing Address - Zip Code:85309-1529
Mailing Address - Country:US
Mailing Address - Phone:623-856-7982
Mailing Address - Fax:
Practice Address - Street 1:7219 N LITCHFIELD RD BLDG 1130
Practice Address - Street 2:
Practice Address - City:LUKE AFB
Practice Address - State:AZ
Practice Address - Zip Code:85309-1529
Practice Address - Country:US
Practice Address - Phone:623-856-7982
Practice Address - Fax:623-856-2777
Is Sole Proprietor?:No
Enumeration Date:2020-10-29
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ236616363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ089242Medicaid