Provider Demographics
NPI:1386163806
Name:DE VERA, RUSSEL IBIAS (MSN, NP-C)
Entity type:Individual
Prefix:MR
First Name:RUSSEL
Middle Name:IBIAS
Last Name:DE VERA
Suffix:
Gender:M
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 MIDLANDS CIR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6461
Mailing Address - Country:US
Mailing Address - Phone:410-322-6531
Mailing Address - Fax:
Practice Address - Street 1:3323 MIDLANDS CIR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6461
Practice Address - Country:US
Practice Address - Phone:410-322-6531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX704882163WC0200X
TXAP134775363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine