Provider Demographics
NPI:1861615684
Name:BARRY, DONNA M (APN-C)
Entity type:Individual
Prefix:MS
First Name:DONNA
Middle Name:M
Last Name:BARRY
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 CRESTVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2823
Mailing Address - Country:US
Mailing Address - Phone:973-377-2268
Mailing Address - Fax:
Practice Address - Street 1:1 NORMAL AVE
Practice Address - Street 2:MONTCLAIR STATE UNIVERSITY HEALTH CENTER, BLANTON HALL
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1624
Practice Address - Country:US
Practice Address - Phone:973-655-7470
Practice Address - Fax:973-655-4159
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN055364000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily