Provider Demographics
NPI:1497896062
Name:BARCLAY, ELAINE CAROL (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:CAROL
Last Name:BARCLAY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:YOUNG AMERICA
Mailing Address - State:MN
Mailing Address - Zip Code:55397-9624
Mailing Address - Country:US
Mailing Address - Phone:952-467-3221
Mailing Address - Fax:
Practice Address - Street 1:1300 E. CLIFF ROAD
Practice Address - Street 2:JHU PBG WELLNESS CENTER
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337
Practice Address - Country:US
Practice Address - Phone:952-895-2528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 065689 4363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily