Healthcare Provider Details

I. General information

NPI: 1699308049
Provider Name (Legal Business Name): COLLETTE BARR APRDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3581 W NORTHERN AVE STE 8
PHOENIX AZ
85051-9404
US

IV. Provider business mailing address

4037 E GARNET CIR
MESA AZ
85206-3266
US

V. Phone/Fax

Practice location:
  • Phone: 480-830-9555
  • Fax: 480-499-0083
Mailing address:
  • Phone: 480-830-9555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH3090
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: