Provider Demographics
NPI:1588941397
Name:BARR, ELIZABETH (PMHNP, CPNP, DNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BARR
Suffix:
Gender:F
Credentials:PMHNP, CPNP, DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3226
Mailing Address - Country:US
Mailing Address - Phone:360-906-7156
Mailing Address - Fax:360-696-3658
Practice Address - Street 1:2215 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3226
Practice Address - Country:US
Practice Address - Phone:360-906-7156
Practice Address - Fax:360-696-3658
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-08
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201150136NP363LP0200X
OR201604306NP-PP363LP0808X
WAAP60556930363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60556930OtherWASHINGTON DEPARTMENT OF HEALTH
OR201604306NPOtherOREGON STATE BOARD OF NURSING
OR201150136NPOtherOREGON STATE BOARD OF NURSING