Basic Information
Provider Information
NPI: 1679779722
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARNEY
FirstName: ELISE
MiddleName: JOYCE
NamePrefix: DR.
NameSuffix:  
Credential: D.O.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2149 E WARNER RD STE 102
Address2:  
City: TEMPE
State: AZ
PostalCode: 852843495
CountryCode: US
TelephoneNumber: 4806106100
FaxNumber:  
Practice Location
Address1: 7362 W THUNDERBIRD RD
Address2:  
City: PEORIA
State: AZ
PostalCode: 853815028
CountryCode: US
TelephoneNumber: 6028435455
FaxNumber: 6028438426
Other Information
ProviderEnumerationDate: 06/25/2007
LastUpdateDate: 01/03/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300X5438AZY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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