Healthcare Provider Details

I. General information

NPI: 1174090260
Provider Name (Legal Business Name): BRITTANY JEAN BARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2018
Last Update Date: 10/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

759 PALMYRA ST
SULLIVAN WI
53178-9608
US

IV. Provider business mailing address

759 PALMYRA ST
SULLIVAN WI
53178-9608
US

V. Phone/Fax

Practice location:
  • Phone: 262-777-1315
  • Fax:
Mailing address:
  • Phone: 262-777-1315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86002531
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: