Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 8490-33 | WI |
NPI | 1033502919 |
---|---|
Provider Name | Mr. Christopher Thomas Ramos |
First Address | Olympia, WA 98512-2034 |
Second Address | Tumwater, WA 98512-6218 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2015 |
Last Update Date | 14/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8490-33 | STATE OF WISCONSIN (01) | WI |