Provider Demographics
NPI:1699103945
Name:REILLY, BARBARA (RN, PHN)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:REILLY
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S 12TH ST
Mailing Address - Street 2:SUITE 4710-MC635
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1004
Mailing Address - Country:US
Mailing Address - Phone:612-348-0173
Mailing Address - Fax:612-272-7961
Practice Address - Street 1:330 S 12TH ST
Practice Address - Street 2:SUITE 4710-MC635
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1004
Practice Address - Country:US
Practice Address - Phone:612-348-0173
Practice Address - Fax:612-272-7961
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR129272-3163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse