Healthcare Provider Details

I. General information

NPI: 1053670190
Provider Name (Legal Business Name): VERONICA MARIE IBARRA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2012
Last Update Date: 07/15/2024
Certification Date: 07/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2270 COMMERCIAL DR UNIT 2
PAHRUMP NV
89048-4704
US

IV. Provider business mailing address

2270 COMMERCIAL DR UNIT 2
PAHRUMP NV
89048-4704
US

V. Phone/Fax

Practice location:
  • Phone: 775-318-9300
  • Fax: 775-318-9318
Mailing address:
  • Phone: 775-318-9300
  • Fax: 775-318-9318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN001377
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: