Provider Demographics
NPI:1548986516
Name:YBARRA, JENNIFER NICHOLE (LPN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:NICHOLE
Last Name:YBARRA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:NICHOLE
Other - Last Name:STRAUBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:3271 N BLACK ROCK RD
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85396-8354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:255 E WIGWAM BLVD
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340
Practice Address - Country:US
Practice Address - Phone:623-535-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP0443476164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse