Provider Demographics
NPI:1952734667
Name:BARRETT, BOBBIE J (RN)
Entity Type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:J
Last Name:BARRETT
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:N5179 AXDEN RD.
Mailing Address - Street 2:
Mailing Address - City:GLEASON
Mailing Address - State:WI
Mailing Address - Zip Code:54435
Mailing Address - Country:US
Mailing Address - Phone:715-219-5007
Mailing Address - Fax:
Practice Address - Street 1:N5179 AXEN RD
Practice Address - Street 2:
Practice Address - City:GLEASON
Practice Address - State:WI
Practice Address - Zip Code:54435-9778
Practice Address - Country:US
Practice Address - Phone:715-219-5007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19681830163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse