Healthcare Provider Details

I. General information

NPI: 1508091885
Provider Name (Legal Business Name): DEBRA ANN BARILETTI FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2009
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SHANE BLDG.
ARLINGTON OR
97812
US

IV. Provider business mailing address

110 SHANE BLDG BOX 314
ARLINGTON OR
97812
US

V. Phone/Fax

Practice location:
  • Phone: 541-454-2888
  • Fax: 541-454-2988
Mailing address:
  • Phone: 541-454-2888
  • Fax: 541-454-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200950037NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: