Provider Demographics
NPI:1760922827
Name:BARICKMAN, SHANEA
Entity Type:Individual
Prefix:
First Name:SHANEA
Middle Name:
Last Name:BARICKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 11TH AVE
Mailing Address - Street 2:313
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-1545
Mailing Address - Country:US
Mailing Address - Phone:970-888-2855
Mailing Address - Fax:
Practice Address - Street 1:3222 11TH AVE
Practice Address - Street 2:313
Practice Address - City:EVANS
Practice Address - State:CO
Practice Address - Zip Code:80620-1545
Practice Address - Country:US
Practice Address - Phone:970-888-2855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONA.0076853374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide