Healthcare Provider Details

I. General information

NPI: 1821959784
Provider Name (Legal Business Name): LARRY THOMAS BARETTE JR. RN, BSN, PCCN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2025
Last Update Date: 11/25/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ARCHER RD
BEDFORD OH
44146-2927
US

IV. Provider business mailing address

800 ARCHER RD
BEDFORD OH
44146-2927
US

V. Phone/Fax

Practice location:
  • Phone: 845-392-2976
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number479738
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: