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
1	363LF0000X	Family Nurse Practitioner	130515	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID 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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