Provider Demographics
NPI:1720468010
Name:PRUDEN, NATALYA (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:NATALYA
Middle Name:
Last Name:PRUDEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:NATALYA
Other - Middle Name:V
Other - Last Name:DEVEGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:2021 N MACARTHUR BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2210
Mailing Address - Country:US
Mailing Address - Phone:972-253-2560
Mailing Address - Fax:972-253-4218
Practice Address - Street 1:2021 N MACARTHUR BLVD STE 350
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2217
Practice Address - Country:US
Practice Address - Phone:972-253-2515
Practice Address - Fax:972-253-4218
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX780274364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health