Provider Demographics
NPI:1114517471
Name:BARA, ALLISON KATHLEEN (NP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:KATHLEEN
Last Name:BARA
Suffix:
Gender:F
Credentials:NP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23052 AUDETTE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-2604
Mailing Address - Country:US
Mailing Address - Phone:313-574-9692
Mailing Address - Fax:
Practice Address - Street 1:23000 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-9265
Practice Address - Country:US
Practice Address - Phone:734-304-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2121060953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily