Provider Demographics
NPI:1073023081
Name:LARUE, BARBARA J
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:LARUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72801-2725
Mailing Address - Country:US
Mailing Address - Phone:479-968-1198
Mailing Address - Fax:
Practice Address - Street 1:1915 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72801-7280
Practice Address - Country:US
Practice Address - Phone:479-968-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR098644163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse