Provider Demographics
NPI:1992247803
Name:DE LUA-RUIZ, NEDIA NICOLE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:NEDIA
Middle Name:NICOLE
Last Name:DE LUA-RUIZ
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 WOOLDRIDGE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2916
Mailing Address - Country:US
Mailing Address - Phone:361-356-6441
Mailing Address - Fax:606-439-6855
Practice Address - Street 1:6625 WOOLDRIDGE RD
Practice Address - Street 2:STE 101
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2916
Practice Address - Country:US
Practice Address - Phone:361-356-6441
Practice Address - Fax:606-439-6855
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX132546363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health