Provider Demographics
NPI:1790027019
Name:WASHINGTON, RONICE NICHOLE
Entity Type:Individual
Prefix:
First Name:RONICE
Middle Name:NICHOLE
Last Name:WASHINGTON
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 1:2953 N GATEWAY RD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-7452
Mailing Address - Country:US
Mailing Address - Phone:702-265-5332
Mailing Address - Fax:
Practice Address - Street 1:2953 N GATEWAY RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-7452
Practice Address - Country:US
Practice Address - Phone:702-265-5332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner