Provider Demographics
NPI:1346826336
Name:BAREBO, JUSTIN CODY (CRNA)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:CODY
Last Name:BAREBO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 TOWNSHIP ROAD 1525
Mailing Address - Street 2:
Mailing Address - City:PROCTORVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45669-8072
Mailing Address - Country:US
Mailing Address - Phone:304-942-5333
Mailing Address - Fax:
Practice Address - Street 1:458 TOWNSHIP ROAD 1525
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-8072
Practice Address - Country:US
Practice Address - Phone:304-942-5333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV92682163WC0200X
WV109962367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine