Provider Demographics
NPI:1780443739
Name:NEWLAND, GRACE CY JEAN (NP)
Entity type:Individual
Prefix:MISS
First Name:GRACE CY
Middle Name:JEAN
Last Name:NEWLAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:907 S WINDHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:NEW PALESTINE
Mailing Address - State:IN
Mailing Address - Zip Code:46163-8882
Mailing Address - Country:US
Mailing Address - Phone:317-318-4318
Mailing Address - Fax:
Practice Address - Street 1:334 N SENATE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1708
Practice Address - Country:US
Practice Address - Phone:224-760-7322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015058A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner