Provider Demographics
NPI:1639350697
Name:NEWMAN, VIRGINIA ROSE (PA)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:ROSE
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 RIM DR
Mailing Address - Street 2:170 MILLER BLDG
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-3911
Mailing Address - Country:US
Mailing Address - Phone:970-247-7355
Mailing Address - Fax:970-247-7621
Practice Address - Street 1:1000 RIM DR
Practice Address - Street 2:170 MILLER BLDG
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-3911
Practice Address - Country:US
Practice Address - Phone:970-247-7355
Practice Address - Fax:970-247-7621
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant