Healthcare Provider Details

I. General information

NPI: 1851969877
Provider Name (Legal Business Name): MIKALA RAMIREZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIKALA RAENEZ EARLY

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 11/06/2021
Certification Date: 11/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 ELLINGTON DR
RAYVILLE LA
71269-3632
US

IV. Provider business mailing address

117 ELLINGTON DR
RAYVILLE LA
71269-3632
US

V. Phone/Fax

Practice location:
  • Phone: 318-728-0281
  • Fax: 318-728-0282
Mailing address:
  • Phone: 318-728-0281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number221859
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN152971
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: