Provider Demographics
NPI:1922420710
Name:BARE, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:KIM
Other - Last Name:BARE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:220 W WILLOW ST
Mailing Address - Street 2:BLDG. A
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70501-2837
Mailing Address - Country:US
Mailing Address - Phone:337-262-5616
Mailing Address - Fax:337-262-1310
Practice Address - Street 1:220 W WILLOW ST
Practice Address - Street 2:BLDG. A
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-2837
Practice Address - Country:US
Practice Address - Phone:337-262-5616
Practice Address - Fax:337-262-1310
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN077122163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health