Provider Demographics
NPI:1578559738
Name:BARABASH, THERESA M (CNP)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:M
Last Name:BARABASH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
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Mailing Address - Street 1:3355 GLENDALE AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-7146
Mailing Address - Fax:419-383-2050
Practice Address - Street 1:2222 CHERRY ST
Practice Address - Street 2:STE 1800
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2673
Practice Address - Country:US
Practice Address - Phone:419-251-8027
Practice Address - Fax:419-251-7766
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2008-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHRN272905363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2441316Medicaid
OHBANP14112Medicare ID - Type Unspecified
OH2441316Medicaid