Healthcare Provider Details

I. General information

NPI: 1538152251
Provider Name (Legal Business Name): GLORIA JEANNE BARKER CNS, APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 S MAIN ST SUITE 305
ELKHART IN
46516-3102
US

IV. Provider business mailing address

307 S MAIN ST SUITE 305
ELKHART IN
46516-3102
US

V. Phone/Fax

Practice location:
  • Phone: 574-523-3347
  • Fax: 574-296-7560
Mailing address:
  • Phone: 574-523-3347
  • Fax: 574-296-7560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number28120530A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: