Provider Demographics
NPI:1598032088
Name:NEWLIN, FLORA M
Entity Type:Individual
Prefix:
First Name:FLORA
Middle Name:M
Last Name:NEWLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1897 TUNDRA WAY
Mailing Address - Street 2:PO BOX 189
Mailing Address - City:NOORVIK
Mailing Address - State:AK
Mailing Address - Zip Code:99763-0189
Mailing Address - Country:US
Mailing Address - Phone:907-636-2103
Mailing Address - Fax:907-636-2195
Practice Address - Street 1:1897 TUNDRA WAY
Practice Address - Street 2:
Practice Address - City:NOORVIK
Practice Address - State:AK
Practice Address - Zip Code:99763-0189
Practice Address - Country:US
Practice Address - Phone:907-636-2103
Practice Address - Fax:907-636-2195
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK03-629-P172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker