Provider Demographics
NPI:1922690338
Name:BARR, SHANTRICE LYNNE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SHANTRICE
Middle Name:LYNNE
Last Name:BARR
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-5222
Mailing Address - Country:US
Mailing Address - Phone:310-272-0423
Mailing Address - Fax:
Practice Address - Street 1:810 ESSEX ST
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-5222
Practice Address - Country:US
Practice Address - Phone:310-272-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016573363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily