Provider Demographics
NPI:1790590610
Name:BARNES, MARCIA L
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 PACIFIC ST APT D1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-5443
Mailing Address - Country:US
Mailing Address - Phone:718-496-9915
Mailing Address - Fax:
Practice Address - Street 1:1304 PACIFIC ST APT D1
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-5443
Practice Address - Country:US
Practice Address - Phone:718-496-9915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5254533164X00000X
376J00000X
NY345363164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
No376J00000XNursing Service Related ProvidersHomemaker