Provider Demographics
NPI:1851862478
Name:BARNES, TINISHA MONIQUE (LPN)
Entity Type:Individual
Prefix:MISS
First Name:TINISHA
Middle Name:MONIQUE
Last Name:BARNES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211-3337
Mailing Address - Country:US
Mailing Address - Phone:716-816-3741
Mailing Address - Fax:716-897-8179
Practice Address - Street 1:95 JOHN MUIR DR
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-1144
Practice Address - Country:US
Practice Address - Phone:716-541-2639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318144164W00000X
NY318144-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY318144-1OtherLPN