Provider Demographics
NPI:1437426913
Name:BARR, ROSIE (CHP)
Entity Type:Individual
Prefix:MISS
First Name:ROSIE
Middle Name:
Last Name:BARR
Suffix:
Gender:F
Credentials:CHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 BACK STREET
Mailing Address - Street 2:
Mailing Address - City:SHUNGNAK
Mailing Address - State:AK
Mailing Address - Zip Code:99773-0080
Mailing Address - Country:US
Mailing Address - Phone:907-442-3321
Mailing Address - Fax:907-442-7307
Practice Address - Street 1:80 BACK STREET
Practice Address - Street 2:
Practice Address - City:SHUNGNAK
Practice Address - State:AK
Practice Address - Zip Code:99773-0080
Practice Address - Country:US
Practice Address - Phone:907-437-2138
Practice Address - Fax:907-437-2139
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK00-434-P172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK00-434-PMedicaid