Provider Demographics
NPI:1295359321
Name:BARKER, YVONNE SIMONE III
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:SIMONE
Last Name:BARKER
Suffix:III
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 1:4700 ARBOR DR APT 215
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3007
Mailing Address - Country:US
Mailing Address - Phone:847-890-3121
Mailing Address - Fax:
Practice Address - Street 1:4700 ARBOR DR APT 215
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3007
Practice Address - Country:US
Practice Address - Phone:847-890-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL383879402251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL383879402Medicaid