Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 4704211851 | MI |
N | 363LA2200X | Nurse Practitioner - Adult Health | 4704211851 | MI |
NPI | 1013184068 |
---|---|
Provider Name | Monica G Barry |
First Address | Ann Arbor, MI 48108 |
Second Address | Ann Arbor, MI 48109-5364 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2008 |
Last Update Date | 11/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0P33590 | MEDICARE GROUP PIN (01) | |
MB211851 | BCBS STATE LICENSE (01) | MI |
P33590012 | MEDICARE IND PIN (01) |