1346252103 NPI number — CORRAINE ANNETTE YBARRA LPN

Table of content: CORRAINE ANNETTE YBARRA LPN (NPI 1346252103)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346252103 NPI number — CORRAINE ANNETTE YBARRA LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YBARRA
Provider First Name:
CORRAINE
Provider Middle Name:
ANNETTE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346252103
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
USAMEDDAC WUERZBURG, UNIT 26610
Provider Second Line Business Mailing Address:
ATTN: CREDENTIALS OFFICE
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
011499318043
Provider Business Mailing Address Fax Number:
011499318043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USAMEDDAC WUERZBURG, UNIT 26610
Provider Second Line Business Practice Location Address:
US ARMY HEALTH CLINIC WUERZBURG
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
011499318043
Provider Business Practice Location Address Fax Number:
011499318043
Provider Enumeration Date:
08/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  LPN0000044496 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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