Provider Demographics
NPI:1174831200
Name:BLACK, BARB (RN)
Entity type:Individual
Prefix:MRS
First Name:BARB
Middle Name:
Last Name:BLACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5023 STATE ROUTE 40
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:NY
Mailing Address - Zip Code:12809-7798
Mailing Address - Country:US
Mailing Address - Phone:518-638-8243
Mailing Address - Fax:518-638-6075
Practice Address - Street 1:5023 STATE ROUTE 40
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:NY
Practice Address - Zip Code:12809-7798
Practice Address - Country:US
Practice Address - Phone:518-638-8243
Practice Address - Fax:518-638-6075
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22-300586163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool