Individual
TYANNA BARNES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
85 HERRICK ST, BEVERLY, MA 01915-1790
(978) 816-2501
Mailing address
PROVIDER ENROLLMENT 41 MALL ROAD, BURLINGTON, MA 01805-0001
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
72961
CT
367500000X
Certified Registered Nurse Anesthetist
Primary
RN2260048
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
72961
LICENSE
CT
Enumeration date
08/05/2006
Last updated
01/05/2024
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