Provider Demographics
NPI:1346369428
Name:LYBARGER, MARYJANE (CNA)
Entity Type:Individual
Prefix:MRS
First Name:MARYJANE
Middle Name:
Last Name:LYBARGER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 ARGYLE ST
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-2602
Mailing Address - Country:US
Mailing Address - Phone:559-782-0326
Mailing Address - Fax:
Practice Address - Street 1:1701 W KANAI AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-1873
Practice Address - Country:US
Practice Address - Phone:559-782-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00508121OtherNURSE ASSISTANT CERTIFICA