MEDICARE: PRISCILLA BARNES

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	376K00000X	Nurse's Aide		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B652-6608-3783	OTHER	IL	DRIVERS LICENSE

General Provider Information

NPI Number	:	1942864012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLA BARNES

Provider Business Mailing Address
First Line	:	6155 S FRANCISCO AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-2331
Country	:	US
Telephone Number	:	708-673-1660
Fax Number	:

Provider Business Practice Location Address
First Line	:	6155 S FRANCISCO AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60629-2331
Country	:	US
Telephone Number	:	708-673-1660
Fax Number	:

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

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	04/24/2019

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Directions to “ PRISCILLA BARNES ” Practice Location

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