Healthcare Provider Details

I. General information

NPI: 1699480236
Provider Name (Legal Business Name): DIANA J BARNES BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 NEW YORK AVE APT 3B
BROOKLYN NY
11210-1628
US

IV. Provider business mailing address

1408 NEW YORK AVE APT 3B
BROOKLYN NY
11210-1628
US

V. Phone/Fax

Practice location:
  • Phone: 347-715-8617
  • Fax:
Mailing address:
  • Phone: 212-864-4351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number317419
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number317419
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number317419
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: