Provider Demographics
NPI:1710613385
Name:NALLA, ROSA JUAREZ
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:JUAREZ
Last Name:NALLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7908 AVENUE N
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-6955
Mailing Address - Country:US
Mailing Address - Phone:432-260-4549
Mailing Address - Fax:
Practice Address - Street 1:7908 AVENUE N
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-6955
Practice Address - Country:US
Practice Address - Phone:432-260-4549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX908806363LA2100X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care