Provider Demographics
NPI:1962906586
Name:VIDEVA, NATALIA (APRN)
Entity type:Individual
Prefix:
First Name:NATALIA
Middle Name:
Last Name:VIDEVA
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 1:5105 CAMINO AL NORTE
Mailing Address - Street 2:STE 100
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-2373
Mailing Address - Country:US
Mailing Address - Phone:702-750-2438
Mailing Address - Fax:
Practice Address - Street 1:5105 CAMINO AL NORTE STE 100
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-2373
Practice Address - Country:US
Practice Address - Phone:702-750-2438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN002844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily