Provider Demographics
NPI:1720596869
Name:RAMIREZ, MAIRANI VANESSA
Entity Type:Individual
Prefix:MS
First Name:MAIRANI
Middle Name:VANESSA
Last Name:RAMIREZ
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 1:7245 SUNDOWN RD
Mailing Address - Street 2:
Mailing Address - City:WINNEMUCCA
Mailing Address - State:NV
Mailing Address - Zip Code:89445-9318
Mailing Address - Country:US
Mailing Address - Phone:775-389-9617
Mailing Address - Fax:
Practice Address - Street 1:1360 NANNETTE CIR APT 8
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-4463
Practice Address - Country:US
Practice Address - Phone:775-389-9617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-10
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
NV12038957763747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1203805776Medicaid