Provider Demographics
NPI:1992529747
Name:NOVOA ARRENDONDO, MAYRA
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:NOVOA ARRENDONDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:NE
Mailing Address - Zip Code:68866-0190
Mailing Address - Country:US
Mailing Address - Phone:308-388-2041
Mailing Address - Fax:
Practice Address - Street 1:303 W CHURCH ST.
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:NE
Practice Address - Zip Code:68866
Practice Address - Country:US
Practice Address - Phone:308-388-2041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant