Provider Demographics
NPI:1033520820
Name:STORM, RASHILDA AYANNA (MSN, AGPCNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:RASHILDA
Middle Name:AYANNA
Last Name:STORM
Suffix:
Gender:F
Credentials:MSN, AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6805
Mailing Address - Country:US
Mailing Address - Phone:209-384-6493
Mailing Address - Fax:
Practice Address - Street 1:857 W CHILDS AVE
Practice Address - Street 2:GERIATRICS
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-6862
Practice Address - Country:US
Practice Address - Phone:209-385-5600
Practice Address - Fax:209-385-5674
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF306806-1363LA2200X
NYF340948-1363LG0600X
CARN95091386163W00000X
CANP95004311363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse