Provider Demographics
NPI:1831438191
Name:BARCLAY, KAIJA (LPN)
Entity type:Individual
Prefix:
First Name:KAIJA
Middle Name:
Last Name:BARCLAY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2418 OLINVILLE AVE
Mailing Address - Street 2:APT 2A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-7621
Mailing Address - Country:US
Mailing Address - Phone:718-717-4254
Mailing Address - Fax:
Practice Address - Street 1:2418 OLINVILLE AVE
Practice Address - Street 2:APT 2A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-7621
Practice Address - Country:US
Practice Address - Phone:718-717-4254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310685164W00000X
CT37482164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse