Provider Demographics
NPI:1760844435
Name:YBARRA, MARISIA ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:MARISIA
Middle Name:ANNE
Last Name:YBARRA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 HUNSAKER LN
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97404-2477
Mailing Address - Country:US
Mailing Address - Phone:541-521-7176
Mailing Address - Fax:
Practice Address - Street 1:33142 CAMAS SWALE RD
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426-9732
Practice Address - Country:US
Practice Address - Phone:541-510-3919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201601737LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR695514OtherSENIOR AND DISABLED SERVICES