Provider Demographics
NPI:1053432971
Name:BRITTELL, BARBARA (PAC)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BRITTELL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1100
Mailing Address - Street 2:RCMS
Mailing Address - City:GUALALA
Mailing Address - State:CA
Mailing Address - Zip Code:95445
Mailing Address - Country:US
Mailing Address - Phone:707-884-4005
Mailing Address - Fax:
Practice Address - Street 1:28522 MARLBORO AVE STE C
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2792
Practice Address - Country:US
Practice Address - Phone:443-746-0086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
MDC03626363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical