Provider Demographics
NPI:1205675477
Name:BARRY DE LA CRUZ, AMINATOU (RN)
Entity type:Individual
Prefix:
First Name:AMINATOU
Middle Name:
Last Name:BARRY DE LA CRUZ
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 1:78 HAMILTON ST APT 1
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-2266
Mailing Address - Country:US
Mailing Address - Phone:774-253-6267
Mailing Address - Fax:
Practice Address - Street 1:EDWARD M KENNEDY COMMUNITY HEALTH CENTER
Practice Address - Street 2:605 LINCOLN ST
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-852-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-20
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2373159163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse