MEDICARE: LETIZIA A BARNES APN

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		IL

General Provider Information

NPI Number	:	1114085487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETIZIA A BARNES APN

Provider Business Mailing Address
First Line	:	335 N MASON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-2130
Country	:	US
Telephone Number	:	773-378-3621
Fax Number	:	773-378-4028

Provider Business Practice Location Address
First Line	:	335 N MASON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-2130
Country	:	US
Telephone Number	:	773-378-3621
Fax Number	:	773-378-4028

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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