Healthcare Provider Details

I. General information

NPI: 1669484416
Provider Name (Legal Business Name): DENISE C BARNES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 HOLMGREN WAY
GREEN BAY WI
54304-5224
US

IV. Provider business mailing address

2401 HOLMGREN WAY
GREEN BAY WI
54304-5224
US

V. Phone/Fax

Practice location:
  • Phone: 920-497-0003
  • Fax: 920-497-0023
Mailing address:
  • Phone: 920-497-0003
  • Fax: 920-497-0023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number110447
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: