Provider Demographics
NPI:1346518370
Name:BARLOW, ANNIE J (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:J
Last Name:BARLOW
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:J
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6241 15TH AVE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-1739
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3303 S BOND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4501
Practice Address - Country:US
Practice Address - Phone:503-494-6597
Practice Address - Fax:503-494-5385
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHEL11534363A00000X
MN11439363A00000X
ORPA218233363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN720789Medicare PIN
NDN720790Medicare PIN