Provider Demographics
NPI:1447940838
Name:NEWCOMB, PHILLIP (APRN)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:
Last Name:NEWCOMB
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13616 CALIFORNIA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-5336
Mailing Address - Country:US
Mailing Address - Phone:402-496-0404
Mailing Address - Fax:402-496-7766
Practice Address - Street 1:13616 CALIFORNIA ST STE 100
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-5336
Practice Address - Country:US
Practice Address - Phone:402-496-0404
Practice Address - Fax:402-496-7766
Is Sole Proprietor?:No
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE77580363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner