Provider Demographics
NPI:1972893261
Name:BARNES, ANDRENA (RN)
Entity Type:Individual
Prefix:
First Name:ANDRENA
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 RAILROAD AVE # 172
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2204
Mailing Address - Country:US
Mailing Address - Phone:917-283-8316
Mailing Address - Fax:
Practice Address - Street 1:17030 130TH AVE APT 5C
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434
Practice Address - Country:US
Practice Address - Phone:347-232-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-08
Last Update Date:2023-08-17
Deactivation Date:2012-03-12
Deactivation Code:
Reactivation Date:2017-07-13
Provider Licenses
StateLicense IDTaxonomies
NY640068163W00000X
NY308004363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse