=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053043034
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARMETHA RAMANAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2022
-----------------------------------------------------
Last Update Date | 08/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6677 SANTA MONICA BLVD APT 4711
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90038-1994
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-697-6412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 WINSTON AVE
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01887-2844
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-697-6412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 95021790
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN2347915
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------