Provider Demographics
NPI:1841879772
Name:BARRERA, JEAN MARIE (ND)
Entity type:Individual
Prefix:DR
First Name:JEAN MARIE
Middle Name:
Last Name:BARRERA
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 W CROCKETT ST APT 214
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-2674
Mailing Address - Country:US
Mailing Address - Phone:916-847-0616
Mailing Address - Fax:
Practice Address - Street 1:8 W CROCKETT ST APT 214
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-2674
Practice Address - Country:US
Practice Address - Phone:916-847-0616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61007532208D00000X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine