=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215993605
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JONATHAN ALEXANDER BARBER SR. FNP-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2006
-----------------------------------------------------
Last Update Date | 09/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41 MAIN ST
-----------------------------------------------------
City | OAKFIELD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14125-1014
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-948-8077
-----------------------------------------------------
Fax | 585-948-9159
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 MIX PL
-----------------------------------------------------
City | BATAVIA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14020-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-230-4579
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F3343401
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------