Provider Demographics
NPI:1831491448
Name:NAVA, NICOLE JOANA
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:JOANA
Last Name:NAVA
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 1:4753 OPAL BAY CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89139-7140
Mailing Address - Country:US
Mailing Address - Phone:702-677-2640
Mailing Address - Fax:
Practice Address - Street 1:4753 OPAL BAY CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89139-7140
Practice Address - Country:US
Practice Address - Phone:702-677-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner