Provider Demographics
NPI:1730665415
Name:NEWSOME, LA MICHAEL Q (RN)
Entity Type:Individual
Prefix:
First Name:LA MICHAEL
Middle Name:Q
Last Name:NEWSOME
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 TOWN CENTER BLVD APT 322
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-6224
Mailing Address - Country:US
Mailing Address - Phone:281-788-0252
Mailing Address - Fax:
Practice Address - Street 1:7404 TOWN CENTER BLVD APT 322
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-6224
Practice Address - Country:US
Practice Address - Phone:281-788-0252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX949649163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse