Provider Demographics
NPI:1487282497
Name:BARROW, DWAYNE SR (NP)
Entity type:Individual
Prefix:
First Name:DWAYNE
Middle Name:
Last Name:BARROW
Suffix:SR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:358 E JAVELINA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-6205
Mailing Address - Country:US
Mailing Address - Phone:562-523-9683
Mailing Address - Fax:562-408-1120
Practice Address - Street 1:358 E JAVELINA AVE STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6205
Practice Address - Country:US
Practice Address - Phone:562-523-9683
Practice Address - Fax:562-408-1120
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010970363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health