Provider Demographics
NPI:1578560199
Name:MAHONEY, BARBARA ANN (RNP)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ANN
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:RNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2476 N BEECHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-4239
Mailing Address - Country:US
Mailing Address - Phone:909-820-0741
Mailing Address - Fax:909-820-4609
Practice Address - Street 1:9961 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:909-427-6896
Practice Address - Fax:909-427-2663
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN255920363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMM0506987OtherDEA
CAP68993Medicare UPIN