Provider Demographics
NPI:1093885014
Name:CHENOWETH, BARBARA ANNE (NP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANNE
Last Name:CHENOWETH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 OLD BILLERICA ROAD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01730-6201
Mailing Address - Country:US
Mailing Address - Phone:781-275-8700
Mailing Address - Fax:781-276-1934
Practice Address - Street 1:100 OLD BILLERICA RD
Practice Address - Street 2:CARLETON-WILLARD VILLAGE CLINIC
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1267
Practice Address - Country:US
Practice Address - Phone:781-275-8700
Practice Address - Fax:781-276-1934
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA183392363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP3159OtherBLUE CROSS BLUE SHIELD
MANP3159OtherBLUE CROSS BLUE SHIELD
S66225Medicare UPIN