MEDICARE: JOYCE STA. MARIA RONAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	614308	CA
2	367500000X	Certified Registered Nurse Anesthetist	95000126	CA
3	367500000X	Certified Registered Nurse Anesthetist	AP146066	TX

General Provider Information

NPI Number	:	1255758660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE STA. MARIA RONAN

Provider Business Mailing Address
First Line	:	4654 LIME STRAIGHT DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-2129
Country	:	US
Telephone Number	:	707-319-0981
Fax Number	:

Provider Business Practice Location Address
First Line	:	4654 LIME STRAIGHT DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89115-2129
Country	:	US
Telephone Number	:	707-319-0981
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2014
Last Update Date	:	05/01/2024

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