Provider Demographics
NPI:1013394584
Name:BARBOUR, MARVA MONIQUE, NATASHA (APN)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:MONIQUE, NATASHA
Last Name:BARBOUR
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1981 MOUNTAINVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3723
Mailing Address - Country:US
Mailing Address - Phone:973-517-9142
Mailing Address - Fax:908-688-2024
Practice Address - Street 1:394 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1221
Practice Address - Country:US
Practice Address - Phone:973-877-6171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-04
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00566200363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily