Provider Demographics
NPI:1720426307
Name:IBARRA, NANCY RUBY (MAE, PPC)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:RUBY
Last Name:IBARRA
Suffix:
Gender:F
Credentials:MAE, PPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-1503
Mailing Address - Country:US
Mailing Address - Phone:307-532-4091
Mailing Address - Fax:
Practice Address - Street 1:501 ALBANY AVE
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-1503
Practice Address - Country:US
Practice Address - Phone:307-532-4091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker