Provider Demographics
NPI:1609088087
Name:NEWTON, COCO (MPH, RD, CCN)
Entity Type:Individual
Prefix:
First Name:COCO
Middle Name:
Last Name:NEWTON
Suffix:
Gender:F
Credentials:MPH, RD, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3672 PROSPECT RD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-9534
Mailing Address - Country:US
Mailing Address - Phone:734-480-1123
Mailing Address - Fax:734-484-4646
Practice Address - Street 1:328 THOMPSON ST
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2264
Practice Address - Country:US
Practice Address - Phone:734-994-6315
Practice Address - Fax:734-994-6637
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NONE133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist