Provider Demographics
NPI:1447369160
Name:NOVELO, MAGDALENA G (RN, CPNP)
Entity type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:G
Last Name:NOVELO
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:864 CENTRAL BLVD
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7551
Mailing Address - Country:US
Mailing Address - Phone:956-541-8334
Mailing Address - Fax:956-541-9738
Practice Address - Street 1:864 CENTRAL BLVD
Practice Address - Street 2:SUITE 2200
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7551
Practice Address - Country:US
Practice Address - Phone:956-541-8334
Practice Address - Fax:956-541-9738
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX678939363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX678939OtherLIC NO.