Provider Demographics
NPI:1336496124
Name:DOUGLAS, BARBARA ADDIE (RN)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ADDIE
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 GARRISON RD
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20784-1725
Mailing Address - Country:US
Mailing Address - Phone:240-447-2453
Mailing Address - Fax:
Practice Address - Street 1:7514 GARRISON RD
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20784-1725
Practice Address - Country:US
Practice Address - Phone:240-447-2453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN62802163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse