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Individual

RONA BALICAS DIVINAGRACIA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
APRN, PMHNP-BC, CCM

Contact information

Practice address
1400 POTTERY AVE, PORT ORCHARD, WA 98366-3711
(360) 895-5000
(877) 516-9023
Mailing address
1400 POTTERY AVE, PORT ORCHARD, WA 98366-3768
(360) 895-5000
(877) 516-9023

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN85093
NV
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
867980
NV
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
AP61575192
WA

Other

Enumeration date
02/15/2022
Last updated
10/15/2024
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