Healthcare Provider Details

I. General information

NPI: 1710613385
Provider Name (Legal Business Name): ROSA JUAREZ NALLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7908 AVENUE N
LUBBOCK TX
79423-6955
US

IV. Provider business mailing address

7908 AVENUE N
LUBBOCK TX
79423-6955
US

V. Phone/Fax

Practice location:
  • Phone: 432-260-4549
  • Fax:
Mailing address:
  • Phone: 432-260-4549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number908806
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number908806
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: