Provider Demographics
NPI:1437866571
Name:PUTMAN, BARBARA JANE (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JANE
Last Name:PUTMAN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:JANE
Other - Last Name:GUTMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4936 W CLARK RD STE 101
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-0861
Mailing Address - Country:US
Mailing Address - Phone:734-434-3000
Mailing Address - Fax:
Practice Address - Street 1:14288 E. OLD US 12
Practice Address - Street 2:SUITE 100
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1889
Practice Address - Country:US
Practice Address - Phone:734-475-9175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704304104363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics