SHANE NEWSOM 390200000X NPI 1578184990

NPI Information

NPI: 1578184990
Provider Name: SHANE NEWSOM, 390200000X
Classification: Contractor - 171W00000X
Entity Type: Individual
Address:
12300 MODESTO AVE NE
ALBUQUERQUE, NM
ZIP 87122
Phone: (505) 553-4835
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Shane Newsom, 390200000X is a contractor in Albuquerque, NM. The provider is a person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering). Shane Newsom, 390200000X NPI is 1578184990. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

12300 MODESTO AVE NE
ALBUQUERQUE, NM
ZIP 87122-232
Phone: (505) 553-4835

The enumeration date for this NPI number is 4/27/2020 and was last updated on 4/27/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	171W00000X	Contractor				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	390200000X	OTHER		STUDENT

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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