Healthcare Provider Details

I. General information

NPI: 1497723589
Provider Name (Legal Business Name): JULIET EUNICE BARNES ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 DAVIS ST
EVANSTON IL
60201-3664
US

IV. Provider business mailing address

3433 GREENWOOD ST
EVANSTON IL
60203-1932
US

V. Phone/Fax

Practice location:
  • Phone: 847-733-7906
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: