Healthcare Provider Details

I. General information

NPI: 1689954448
Provider Name (Legal Business Name): CORINNE LEIGH BARNETT LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSSER LN
BRADFORD PA
16701-3651
US

IV. Provider business mailing address

30 PROSSER LN
BRADFORD PA
16701-3651
US

V. Phone/Fax

Practice location:
  • Phone: 814-596-3650
  • Fax:
Mailing address:
  • Phone: 814-596-3650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number72987641
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number298764
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: