Provider Demographics
NPI:1841766581
Name:NEWSOM, CRISTINA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:NEWSOM
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:NEWSOM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:672 WILTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6138
Mailing Address - Country:US
Mailing Address - Phone:207-778-9531
Mailing Address - Fax:866-644-5928
Practice Address - Street 1:672 WILTON RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6138
Practice Address - Country:US
Practice Address - Phone:207-778-9531
Practice Address - Fax:866-644-5928
Is Sole Proprietor?:No
Enumeration Date:2018-10-21
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139410363LP0808X
MECNP201519363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health