Provider Demographics
NPI:1083135057
Name:IBOS, JOAN MARIE (RN)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:MARIE
Last Name:IBOS
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 1:20153 PALM BLVD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-6453
Mailing Address - Country:US
Mailing Address - Phone:985-718-8075
Mailing Address - Fax:
Practice Address - Street 1:20153 PALM BLVD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70435-6453
Practice Address - Country:US
Practice Address - Phone:985-718-8075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN068535163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health