Provider Demographics
NPI:1659076818
Name:BARBOSA, VIVIANA (CRNP)
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:
Last Name:BARBOSA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2826 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-3506
Mailing Address - Country:US
Mailing Address - Phone:717-635-5987
Mailing Address - Fax:
Practice Address - Street 1:555 RAYMOND ST STE 100
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-3101
Practice Address - Country:US
Practice Address - Phone:610-921-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP027402363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily