Provider Demographics
NPI:1659451359
Name:NEWMAN, CHRISTINE O'CONNELL (CNNP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:O'CONNELL
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:CNNP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:34781 PERTH ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5307
Mailing Address - Country:US
Mailing Address - Phone:734-427-2545
Mailing Address - Fax:313-916-9485
Practice Address - Street 1:2799 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2608
Practice Address - Country:US
Practice Address - Phone:313-916-7524
Practice Address - Fax:313-916-9485
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704136413363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ24657037Medicare PIN