Healthcare Provider Details

I. General information

NPI: 1144389685
Provider Name (Legal Business Name): ILA L BARNES N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 2ND AVE
BROOKLYN NY
11220-3599
US

IV. Provider business mailing address

5610 2ND AVE
BROOKLYN NY
11220-3599
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-6618
  • Fax: 718-630-6878
Mailing address:
  • Phone: 718-630-6618
  • Fax: 718-630-6878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberF420207
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: