Provider Demographics
NPI:1265216477
Name:NEWSOME, CHRISLORIANA
Entity type:Individual
Prefix:
First Name:CHRISLORIANA
Middle Name:
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 GEORGIA AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70062-5502
Mailing Address - Country:US
Mailing Address - Phone:504-877-1781
Mailing Address - Fax:
Practice Address - Street 1:1800 WILLIAMS BLVD STE A
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-8212
Practice Address - Country:US
Practice Address - Phone:504-877-1781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty