Provider Demographics
NPI:1699985168
Name:IBARRA, MONICA L (RN)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:IBARRA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1952 W CALLE ARMENTA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2133
Mailing Address - Country:US
Mailing Address - Phone:520-903-1274
Mailing Address - Fax:
Practice Address - Street 1:2120 N BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2128
Practice Address - Country:US
Practice Address - Phone:520-232-7917
Practice Address - Fax:520-232-7901
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN089062163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ635419Medicaid