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NPI Code Detail

MEDICARE: RENEE A. BARALL FNP

MEDICARE: RENEE A. BARALL FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner130515CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1023006996
Entity Type Code : Individual
Provider Name (Legal Business Name) : RENEE A. BARALL FNP
Provider Business Mailing Address
First Line : PO BOX 50408
Second Line : COLORADO SPRINGS
City : COLORADO SPRINGS
State : CO
Zip : 80949-0408
Country : US
Telephone Number : 719-590-6253
Fax Number :
Provider Business Practice Location Address
First Line : 2767 JANITELL RD
Second Line : COLORADO SPRINGS
City : COLORADO SPRINGS
State : CO
Zip : 80906-4102
Country : US
Telephone Number : 719-365-2889
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2005
Last Update Date : 10/25/2015

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