Basic Information
| Provider Information | |||||||||
| NPI: | 1679541056 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARTH | ||||||||
| FirstName: | DEBORAH | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | NNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3668 PINECREST CT | ||||||||
| Address2: | |||||||||
| City: | EAGAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551231000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512327831 | ||||||||
| FaxNumber: | 6512327826 | ||||||||
| Practice Location | |||||||||
| Address1: | 3668 PINECREST CT | ||||||||
| Address2: | |||||||||
| City: | EAGAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551231000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512327831 | ||||||||
| FaxNumber: | 6512327826 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LN0000X | R127631-2 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
No ID Information.