Healthcare Provider Details

I. General information

NPI: 1033103395
Provider Name (Legal Business Name): MARY JO BARRETO APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2005
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WINTHROP UNIVERSITY HEALTH SERVICES
ROCK HILL SC
29733-0001
US

IV. Provider business mailing address

1101 PALMYRA DR
TEGA CAY SC
29708-8568
US

V. Phone/Fax

Practice location:
  • Phone: 803-323-2206
  • Fax: 803-323-3332
Mailing address:
  • Phone: 803-547-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF89
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: