Provider Demographics
NPI:1235697475
Name:IDECHIIL, BARBARA ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA ANN
Middle Name:
Last Name:IDECHIIL
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:PO BOX 9663
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-5663
Mailing Address - Country:US
Mailing Address - Phone:671-977-2724
Mailing Address - Fax:671-647-1606
Practice Address - Street 1:396 CHALAN SAN ANTONIO BRI BUILDING
Practice Address - Street 2:SUITE 102
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-5663
Practice Address - Country:US
Practice Address - Phone:671-646-6877
Practice Address - Fax:671-647-1606
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GURX0284163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse