Provider Demographics
NPI:1114547676
Name:DESOUSA, BARBARA JANE
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JANE
Last Name:DESOUSA
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:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:ME
Mailing Address - Zip Code:04041-0042
Mailing Address - Country:US
Mailing Address - Phone:207-890-2234
Mailing Address - Fax:
Practice Address - Street 1:86 POST RIDGE
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:ME
Practice Address - Zip Code:04041
Practice Address - Country:US
Practice Address - Phone:207-625-7148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-24
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide