Basic Information
| Provider Information | |||||||||
| NPI: | 1790031946 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARBER | ||||||||
| FirstName: | LAUREL | ||||||||
| MiddleName: | ANNMARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN, NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 FRUITVALE AVE | ||||||||
| Address2: | SUITE 3E | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946012464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105321930 | ||||||||
| FaxNumber: | 5105320963 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 BROADWAY | ||||||||
| Address2: | FIRST FLOOR | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946074099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105321930 | ||||||||
| FaxNumber: | 5109320065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2012 | ||||||||
| LastUpdateDate: | 07/25/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 538891 | CA | N | Nursing Service Providers | Registered Nurse | 363LA2200X | 19262 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LP0808X | 19262 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.