Healthcare Provider Details

I. General information

NPI: 1265170872
Provider Name (Legal Business Name): LOREEN BARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2022
Last Update Date: 05/24/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13929 HARPER AVE
DETROIT MI
48213-3672
US

IV. Provider business mailing address

25765 CRIMSON CT
WARREN MI
48089-4598
US

V. Phone/Fax

Practice location:
  • Phone: 313-371-0055
  • Fax:
Mailing address:
  • Phone: 313-320-3810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number4704386323
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: