Provider Demographics
NPI:1841449840
Name:BARTH, MARY E (RNNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:BARTH
Suffix:
Gender:F
Credentials:RNNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E. TAHQUITZ CANYON WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262
Mailing Address - Country:US
Mailing Address - Phone:760-327-5900
Mailing Address - Fax:760-327-5905
Practice Address - Street 1:1801 E. TAHQUITZ CANYON WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-327-5900
Practice Address - Fax:760-327-5905
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA368612363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3676OtherFURNISHING LICENSE