MEDICARE: DENISE C BARNES 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	163W00000X	Registered Nurse	110447	WI

General Provider Information

NPI Number	:	1669484416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE C BARNES RN

Provider Business Mailing Address
First Line	:	2401 HOLMGREN WAY
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-5224
Country	:	US
Telephone Number	:	920-497-0003
Fax Number	:	920-497-0023

Provider Business Practice Location Address
First Line	:	2401 HOLMGREN WAY
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54304-5224
Country	:	US
Telephone Number	:	920-497-0003
Fax Number	:	920-497-0023

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	03/02/2011

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