Provider Demographics
NPI:1003596578
Name:BARBER, LAUREL CASIMIRA WINSOR (MSHI, PA-C)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:CASIMIRA WINSOR
Last Name:BARBER
Suffix:
Gender:F
Credentials:MSHI, PA-C
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:CASIMIRA
Other - Last Name:BARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5535 WESTMORLAND DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-4817
Mailing Address - Country:US
Mailing Address - Phone:612-382-8733
Mailing Address - Fax:
Practice Address - Street 1:19 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-3715
Practice Address - Country:US
Practice Address - Phone:406-924-5754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
MTMED-PAC-LIC-131074363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program