Healthcare Provider Details

I. General information

NPI: 1174990832
Provider Name (Legal Business Name): DEBORAH BARYCZ I RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2015
Last Update Date: 08/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2766 W 11 MILE RD
BERKLEY MI
48072-3033
US

IV. Provider business mailing address

14003 ADAMS AVE
WARREN MI
48088-5705
US

V. Phone/Fax

Practice location:
  • Phone: 248-542-2424
  • Fax: 228-542-5621
Mailing address:
  • Phone: 586-296-6069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number47041448629
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: