MEDICARE: MS. DONNA M BARRY APN-C

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	26NN055364000	NJ

General Provider Information

NPI Number	:	1861615684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DONNA M BARRY APN-C

Provider Business Mailing Address
First Line	:	53 CRESTVIEW AVE
Second Line	:
City	:	MADISON
State	:	NJ
Zip	:	07940-2823
Country	:	US
Telephone Number	:	973-377-2268
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 NORMAL AVE
Second Line	:	MONTCLAIR STATE UNIVERSITY HEALTH CENTER, BLANTON HALL
City	:	MONTCLAIR
State	:	NJ
Zip	:	07043-1624
Country	:	US
Telephone Number	:	973-655-7470
Fax Number	:	973-655-4159

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

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	07/08/2007

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