MEDICARE: JACQUELINE BARR RN

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	163WH1000X	Hospice Registered Nurse	28200800A	IN

General Provider Information

NPI Number	:	1083227284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE BARR RN

Provider Business Mailing Address
First Line	:	5312 DANIEL DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1654
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5312 DANIEL DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46226-1654
Country	:	US
Telephone Number	:	317-509-1708
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2020
Last Update Date	:	08/26/2020

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