Healthcare Provider Details

I. General information

NPI: 1134137987
Provider Name (Legal Business Name): MARILYN E BAREFOOT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 US HWY 98 SUITE 2A
DAPHNE AL
36526
US

IV. Provider business mailing address

1203 US HWY 98 SUITE 2A
DAPHNE AL
36526
US

V. Phone/Fax

Practice location:
  • Phone: 251-621-9167
  • Fax: 251-621-9003
Mailing address:
  • Phone: 251-621-9167
  • Fax: 251-621-9003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number1046714
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: