Provider Demographics
NPI:1710930987
Name:BARKER, MARIANNE DOROTHY (ARNP)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:DOROTHY
Last Name:BARKER
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 1:4747 N 7TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-3653
Mailing Address - Country:US
Mailing Address - Phone:602-279-7655
Mailing Address - Fax:
Practice Address - Street 1:1255 WEST BASELINE
Practice Address - Street 2:SUITE B258
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-820-0825
Practice Address - Fax:480-820-7863
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2320363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ048256Medicare ID - Type UnspecifiedAHCCCS PROVIDER NUMBER
Z109533Medicare PIN