Provider Demographics
NPI:1427548718
Name:NABOZNY, BARRY JR
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:NABOZNY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3492 BROPHY RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48855-9744
Mailing Address - Country:US
Mailing Address - Phone:810-423-4063
Mailing Address - Fax:
Practice Address - Street 1:1111 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2653
Practice Address - Country:US
Practice Address - Phone:269-428-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide