Healthcare Provider Details

I. General information

NPI: 1366676587
Provider Name (Legal Business Name): ANDREA D. BARNEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CENTER ST.
EAST CARBON UT
84520-0930
US

IV. Provider business mailing address

305 CENTER ST.
EAST CARBON UT
84520-0930
US

V. Phone/Fax

Practice location:
  • Phone: 435-888-4411
  • Fax: 435-888-2270
Mailing address:
  • Phone: 435-888-4411
  • Fax: 435-888-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5646386-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: