Basic Information
Provider Information
NPI: 1003004011
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WEBBER
FirstName: BARBARA
MiddleName: LYNN
NamePrefix: MS.
NameSuffix:  
Credential: L.P.N.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: TERWILLIGER
OtherFirstName: BARBARA
OtherMiddleName: LYNN
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: L.P.N.
OtherLastNameType: 2
Mailing Information
Address1: 221 S MAIN ST
Address2:  
City: CORTLAND
State: NY
PostalCode: 130453251
CountryCode: US
TelephoneNumber: 6077459012
FaxNumber:  
Practice Location
Address1: 221 S MAIN ST
Address2:  
City: CORTLAND
State: NY
PostalCode: 130453251
CountryCode: US
TelephoneNumber: 6077459012
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/04/2007
LastUpdateDate: 10/04/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
164W00000X10170383NYY Nursing Service ProvidersLicensed Practical Nurse 

No ID Information.


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