Provider Demographics
NPI:1295836013
Name:SMITH, RAMONA NICHOLS (NP)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:NICHOLS
Last Name:SMITH
Suffix:
Gender:F
Credentials:NP
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 3137
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95063-3137
Mailing Address - Country:US
Mailing Address - Phone:888-908-0974
Mailing Address - Fax:888-908-0974
Practice Address - Street 1:303 POTRERO ST
Practice Address - Street 2:SUITE 5A
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2741
Practice Address - Country:US
Practice Address - Phone:888-908-0974
Practice Address - Fax:888-908-0974
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16566363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA340864OtherRN
CAZZZ92069ZOtherMEDICARE GROUP ID
CA16566OtherCA BOARD OF REGISTERED NU
CAZZZ04912ZMedicare PIN
CA16566OtherCA BOARD OF REGISTERED NU