Provider Demographics
NPI:1154536894
Name:NAVA, STELLA ANN (LICENSEDNURSE)
Entity type:Individual
Prefix:
First Name:STELLA
Middle Name:ANN
Last Name:NAVA
Suffix:
Gender:F
Credentials:LICENSEDNURSE
Other - Prefix:
Other - First Name:STELLA
Other - Middle Name:
Other - Last Name:RUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICENSEDNURSE
Mailing Address - Street 1:RESTORATIVE HEALTHCARE 800 N. SHORELINE SUITE 700 S
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78401-1282
Mailing Address - Country:US
Mailing Address - Phone:361-937-7887
Mailing Address - Fax:
Practice Address - Street 1:800 N SHORELINE BLVD STE 700S
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-3718
Practice Address - Country:US
Practice Address - Phone:361-937-7887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1348452080P0006X, 164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral Pediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001002785OtherPROVIDER NO.