Healthcare Provider Details

I. General information

NPI: 1174960850
Provider Name (Legal Business Name): PATRICIA ECCLESTON-BARRETT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PATRICIA E BARRETT

II. Dates (important events)

Enumeration Date: 06/04/2013
Last Update Date: 06/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SAINT JOHN AVE
BINGHAMTON NY
13905-4411
US

IV. Provider business mailing address

12 SAINT JOHN AVE
BINGHAMTON NY
13905-4411
US

V. Phone/Fax

Practice location:
  • Phone: 347-385-0090
  • Fax:
Mailing address:
  • Phone: 347-385-0090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number180430
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: