MEDICARE: ALLISON KATHLEEN BARA NP, FNP-BC

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	2121060953	MI

General Provider Information

NPI Number	:	1114517471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON KATHLEEN BARA NP, FNP-BC

Provider Business Mailing Address
First Line	:	23052 AUDETTE ST
Second Line	:
City	:	DEARBORN
State	:	MI
Zip	:	48124-2604
Country	:	US
Telephone Number	:	313-574-9692
Fax Number	:

Provider Business Practice Location Address
First Line	:	23000 TELEGRAPH RD
Second Line	:
City	:	FLAT ROCK
State	:	MI
Zip	:	48134-9265
Country	:	US
Telephone Number	:	734-304-4500
Fax Number	:

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

Provider Enumeration Date	:	01/21/2021
Last Update Date	:	01/21/2021

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