Provider Demographics
NPI:1659617538
Name:NAVARRA, MARVI SOCORRO MACAHILIG (APRN)
Entity Type:Individual
Prefix:
First Name:MARVI SOCORRO
Middle Name:MACAHILIG
Last Name:NAVARRA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7285 S DURANGO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2098
Mailing Address - Country:US
Mailing Address - Phone:702-489-3580
Mailing Address - Fax:702-489-3580
Practice Address - Street 1:7285 S DURANGO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2098
Practice Address - Country:US
Practice Address - Phone:702-407-2933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001450163WG0000X
NVAPRN001450363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAPRN001450OtherNEVADA STATE BOARD OF NURSING
NV1659617538Other1659617538