Provider Demographics
NPI:1144968082
Name:NEWSOME, ELLYCE CAITRIN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:ELLYCE
Middle Name:CAITRIN
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELLYCE
Other - Middle Name:CAITRIN
Other - Last Name:RAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-2006
Mailing Address - Country:US
Mailing Address - Phone:732-610-7919
Mailing Address - Fax:
Practice Address - Street 1:8815 GERMANTOWN AVE STE 31
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2724
Practice Address - Country:US
Practice Address - Phone:215-247-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025752207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine