1386638591 NPI number — MISS ROBERTA BARNES NURSE PRACTITIONER

Table of content: MISS ROBERTA BARNES NURSE PRACTITIONER (NPI 1386638591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386638591 NPI number — MISS ROBERTA BARNES NURSE PRACTITIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARNES
Provider First Name:
ROBERTA
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTITIONER
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386638591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14901 W COEUR DALENE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPIRIT LAKE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83869-8730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-623-2204
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4815 N ASSEMBLY ST
Provider Second Line Business Practice Location Address:
DEPARTMENT OF VETERANS AFFAIRS MEDICAL CENTER
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99205-6185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-434-7000
Provider Business Practice Location Address Fax Number:
509-434-7131
Provider Enumeration Date:
09/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP30006612 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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