Provider Demographics
NPI:1760120562
Name:NEWBURY, MALORI (FNP-C)
Entity type:Individual
Prefix:
First Name:MALORI
Middle Name:
Last Name:NEWBURY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-0155
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-8792
Practice Address - Street 1:6294 STATE HIGHWAY 154
Practice Address - Street 2:
Practice Address - City:SESSER
Practice Address - State:IL
Practice Address - Zip Code:62884-2163
Practice Address - Country:US
Practice Address - Phone:618-625-6979
Practice Address - Fax:618-625-6549
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-23
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209025220363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily