Provider Demographics
NPI:1457990269
Name:NEWVINE, DANA (NP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:NEWVINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5481 COLONY DR N
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-7189
Mailing Address - Country:US
Mailing Address - Phone:989-249-6779
Mailing Address - Fax:989-249-5869
Practice Address - Street 1:5481 COLONY DR N
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-7189
Practice Address - Country:US
Practice Address - Phone:989-249-6779
Practice Address - Fax:989-249-5869
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-26
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704277120363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner