Provider Demographics
NPI:1295926905
Name:NEWMAN, NANCY RO (LPN, LLCC)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:RO
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:LPN, LLCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 WAYZATA BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1209
Mailing Address - Country:US
Mailing Address - Phone:952-545-0200
Mailing Address - Fax:952-545-6388
Practice Address - Street 1:6311 WAYZATA BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-1209
Practice Address - Country:US
Practice Address - Phone:952-545-0200
Practice Address - Fax:952-545-6388
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNL0300043164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse