Healthcare Provider Details

I. General information

NPI: 1922665686
Provider Name (Legal Business Name): MICHAEL BARNETT RN, CNS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1296 ADDIEWELL PL
SAN JOSE CA
95120-3904
US

IV. Provider business mailing address

1296 ADDIEWELL PL
SAN JOSE CA
95120-3904
US

V. Phone/Fax

Practice location:
  • Phone: 408-529-3777
  • Fax:
Mailing address:
  • Phone: 408-529-3777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number827064
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: