Provider Demographics
NPI:1336775170
Name:DEMARES, BARBARA REBEKAH (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:REBEKAH
Last Name:DEMARES
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 RIDGE CREEK CIR UNIT 101
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-4214
Mailing Address - Country:US
Mailing Address - Phone:414-758-0623
Mailing Address - Fax:
Practice Address - Street 1:3169 DEMING WAY
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:WI
Practice Address - Zip Code:53562-1435
Practice Address - Country:US
Practice Address - Phone:608-716-8288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9874363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health