Provider Demographics
NPI:1932854213
Name:DIVINAGRACIA, RONA BALICAS (APRN, PMHNP-BC, CCM)
Entity Type:Individual
Prefix:
First Name:RONA
Middle Name:BALICAS
Last Name:DIVINAGRACIA
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6402 HARLINE HEIGHTS ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-6626
Mailing Address - Country:US
Mailing Address - Phone:702-945-8761
Mailing Address - Fax:702-507-2463
Practice Address - Street 1:6402 HARLINE HEIGHTS ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-6626
Practice Address - Country:US
Practice Address - Phone:702-945-8761
Practice Address - Fax:702-507-2463
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2024-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN85093163W00000X
NV867980363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse