Healthcare Provider Details

I. General information

NPI: 1649212614
Provider Name (Legal Business Name): MONICA AGUSTUS SMITH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W MOANA LN SUITE 100
RENO NV
89509-4932
US

IV. Provider business mailing address

9625 ROLLING ROCK WAY
RENO NV
89521-6134
US

V. Phone/Fax

Practice location:
  • Phone: 775-324-3300
  • Fax: 775-334-3022
Mailing address:
  • Phone: 775-852-3502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN11806
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number283384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: