Basic Information
| Provider Information | |||||||||
| NPI: | 1558471094 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARRY | ||||||||
| FirstName: | EILEEN | ||||||||
| MiddleName: | DALE | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1888 | ||||||||
| Address2: | 45 WASHINGTON ST | ||||||||
| City: | CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038181888 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034476339 | ||||||||
| FaxNumber: | 6034472250 | ||||||||
| Practice Location | |||||||||
| Address1: | 45 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | CONWAY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 038186031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034476339 | ||||||||
| FaxNumber: | 6034472250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 11/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 045181-23-08 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 035272 | 01 | ME | BC/BS | OTHER | 202417 | 01 | NH | CIGNA | OTHER | 225470000 | 05 | ME | MEDICAID | 30340450 | 05 | NH | MEDICAID | 353653 | 01 | NH | MAGELLAN | OTHER | 4003298Y0NH01 | 01 | NH | ANTHEM BC/BS | OTHER | 355544 | 01 | NH | TUFTS | OTHER |