Provider Demographics
NPI:1154084986
Name:BARKER, ANTHONY SHANE (RN)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:SHANE
Last Name:BARKER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 BRADY MILL RD
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:IL
Mailing Address - Zip Code:62906-2306
Mailing Address - Country:US
Mailing Address - Phone:618-833-6343
Mailing Address - Fax:618-833-3345
Practice Address - Street 1:315 BRADY MILL RD
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:IL
Practice Address - Zip Code:62906-2306
Practice Address - Country:US
Practice Address - Phone:618-833-6343
Practice Address - Fax:618-833-3345
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041393474163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator