MEDICARE: IONE BARRERA RN, LVN, PBT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	146N00000X	Basic Emergency Medical Technician	563506	TX
2	164W00000X	Licensed Practical Nurse	PN5247889	FL
3	246RP1900X	Phlebotomy Technician	54902	AK
4	163W00000X	Registered Nurse	1166718	TX

General Provider Information

NPI Number	:	1922683853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IONE BARRERA RN, LVN, PBT

Provider Business Mailing Address
First Line	:	4603 HEATHERS STAR
Second Line	:
City	:	SAINT HEDWIG
State	:	TX
Zip	:	78152-4407
Country	:	US
Telephone Number	:	210-232-4673
Fax Number	:

Provider Business Practice Location Address
First Line	:	4603 HEATHERS STAR
Second Line	:
City	:	SAINT HEDWIG
State	:	TX
Zip	:	78152-4407
Country	:	US
Telephone Number	:	210-232-4673
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2021
Last Update Date	:	06/20/2024

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