Provider Demographics
NPI:1104257005
Name:BARBRE, LAUREN BROOKE
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:BROOKE
Last Name:BARBRE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LAUREN
Other - Middle Name:
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4564 GRANT 19
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:AR
Mailing Address - Zip Code:72057-8834
Mailing Address - Country:US
Mailing Address - Phone:870-917-8183
Mailing Address - Fax:
Practice Address - Street 1:4564 GRANT 19
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:AR
Practice Address - Zip Code:72057
Practice Address - Country:US
Practice Address - Phone:870-917-8183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator