Healthcare Provider Details

I. General information

NPI: 1578302741
Provider Name (Legal Business Name): MRS. CARRIE ANN BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

IV. Provider business mailing address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-1670
  • Fax: 320-202-2330
Mailing address:
  • Phone: 320-252-1670
  • Fax: 320-202-2330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number131992-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: