Provider Demographics
NPI:1407671530
Name:LABARR MAZE, JENNIFER HELENE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HELENE
Last Name:LABARR MAZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9675 W VILLA HERMOSA
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-4331
Mailing Address - Country:US
Mailing Address - Phone:233-332-0563
Mailing Address - Fax:
Practice Address - Street 1:9621 W SPECKLED GECKO DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1705
Practice Address - Country:US
Practice Address - Phone:623-773-6556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-22
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN115909163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool