Provider Demographics
NPI:1952696817
Name:NEWBURN, THELMA LOUISE JESSIE
Entity Type:Individual
Prefix:MS
First Name:THELMA
Middle Name:LOUISE JESSIE
Last Name:NEWBURN
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 1:895 SIERRA VISTA DR
Mailing Address - Street 2:APT 218
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-9385
Mailing Address - Country:US
Mailing Address - Phone:702-488-0015
Mailing Address - Fax:
Practice Address - Street 1:895 SIERRA VISTA DR
Practice Address - Street 2:APT 218
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89169-9385
Practice Address - Country:US
Practice Address - Phone:702-488-0015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner