Provider Demographics
NPI:1538200829
Name:NEWBURRY, JOSLYNN MARIE (RN)
Entity type:Individual
Prefix:MRS
First Name:JOSLYNN
Middle Name:MARIE
Last Name:NEWBURRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOSLYNN
Other - Middle Name:MARIE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:677A E. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49032-8524
Mailing Address - Country:US
Mailing Address - Phone:269-467-1000
Mailing Address - Fax:269-467-3072
Practice Address - Street 1:677A E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MI
Practice Address - Zip Code:49032-8524
Practice Address - Country:US
Practice Address - Phone:269-467-1000
Practice Address - Fax:269-467-3072
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704256233163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1708146Medicaid
MI0656011Medicare ID - Type Unspecified