Provider Demographics
NPI:1952302473
Name:PROVENCE, BARBARA JEANNE (RN CA 226378)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JEANNE
Last Name:PROVENCE
Suffix:
Gender:F
Credentials:RN CA 226378
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Mailing Address - Street 1:24972 TREE AVE
Mailing Address - Street 2:MISSION VIEJO
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-3737
Mailing Address - Country:US
Mailing Address - Phone:949-951-0094
Mailing Address - Fax:
Practice Address - Street 1:26732 CROWN VALLEY PKWY
Practice Address - Street 2:MISSION VIEJO
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6306
Practice Address - Country:US
Practice Address - Phone:949-364-1007
Practice Address - Fax:949-364-0317
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA226378163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA226378OtherRN