1124421862 NPI number — MRS. KERRIANNE O'BRIEN BARRETO NP-C

Table of content: MRS. KERRIANNE O'BRIEN BARRETO NP-C (NPI 1124421862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124421862 NPI number — MRS. KERRIANNE O'BRIEN BARRETO NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARRETO
Provider First Name:
KERRIANNE
Provider Middle Name:
O'BRIEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HANLON
Provider Other First Name:
KERRIANNE
Provider Other Middle Name:
O'BRIEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124421862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
416 BELMONT STREET
Provider Second Line Business Mailing Address:
WORCESTER INTERNAL MEDICINE
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01604-1086
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-756-6609
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
416 BELMONT STREET
Provider Second Line Business Practice Location Address:
WORCESTER INTERNAL MEDICINE
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01604-1086
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-756-6609
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/08/2014

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: 363LA2100X , with the licence number:  RN283028 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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