Healthcare Provider Details

I. General information

NPI: 1790130979
Provider Name (Legal Business Name): TERRY BARNES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2016
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33505 SCHOOLCRAFT RD
LIVONIA MI
48150-1630
US

IV. Provider business mailing address

17 HICKORY CT
DEARBORN HEIGHTS MI
48127-2494
US

V. Phone/Fax

Practice location:
  • Phone: 734-721-0200
  • Fax:
Mailing address:
  • Phone: 313-934-4105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number4704273927
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: