Provider Demographics
NPI:1942646732
Name:ESTRADA, NITA VALERIE
Entity Type:Individual
Prefix:
First Name:NITA
Middle Name:VALERIE
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NITA
Other - Middle Name:VALERIE
Other - Last Name:ESTRADA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1978
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-1978
Mailing Address - Country:US
Mailing Address - Phone:575-623-1480
Mailing Address - Fax:575-622-3325
Practice Address - Street 1:110 E MESCALERO RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-6542
Practice Address - Country:US
Practice Address - Phone:575-623-1480
Practice Address - Fax:575-622-3325
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR36199163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse