Provider Demographics
NPI:1124748751
Name:DE LA CRUZ, ROWENA MARIE (APRN)
Entity type:Individual
Prefix:
First Name:ROWENA
Middle Name:MARIE
Last Name:DE LA CRUZ
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 1:501 CARLTON KAY PL
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-1371
Mailing Address - Country:US
Mailing Address - Phone:702-596-0525
Mailing Address - Fax:
Practice Address - Street 1:3247 S MARYLAND PKWY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2412
Practice Address - Country:US
Practice Address - Phone:702-776-3500
Practice Address - Fax:702-776-3511
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV859083363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health