Provider Demographics
NPI:1558471094
Name:BARRY, EILEEN DALE (ARNP)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:DALE
Last Name:BARRY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1888
Mailing Address - Street 2:45 WASHINGTON ST
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-1888
Mailing Address - Country:US
Mailing Address - Phone:603-447-6339
Mailing Address - Fax:603-447-2250
Practice Address - Street 1:45 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6031
Practice Address - Country:US
Practice Address - Phone:603-447-6339
Practice Address - Fax:603-447-2250
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH045181-23-08363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME035272OtherBC/BS
NH202417OtherCIGNA
ME225470000Medicaid
NH30340450Medicaid
NH353653OtherMAGELLAN
NH4003298Y0NH01OtherANTHEM BC/BS
NH355544OtherTUFTS
ME225470000Medicaid