Provider Demographics
NPI:1992914691
Name:LARA, IRMA A (RNFNP)
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:A
Last Name:LARA
Suffix:
Gender:F
Credentials:RNFNP
Other - Prefix:
Other - First Name:IRMA
Other - Middle Name:A
Other - Last Name:REYNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RNFNP
Mailing Address - Street 1:8708 PUERTO MARQUES
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6213
Mailing Address - Country:US
Mailing Address - Phone:956-724-1104
Mailing Address - Fax:
Practice Address - Street 1:1515 PAPPAS ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-1705
Practice Address - Country:US
Practice Address - Phone:956-795-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX502460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX502460OtherBNE ADVANCE PRACTICE LICE