Healthcare Provider Details

I. General information

NPI: 1184979817
Provider Name (Legal Business Name): LAWRENCE DANA BARKER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COMMERCE DR
SKOWHEGAN ME
04976-4823
US

IV. Provider business mailing address

5 COMMERCE ST
SKOWHEGAN ME
04976
US

V. Phone/Fax

Practice location:
  • Phone: 207-474-8368
  • Fax: 207-474-7794
Mailing address:
  • Phone: 207-474-8368
  • Fax: 207-474-7794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN52429
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: