Provider Demographics
NPI:1063967594
Name:RANAHAN, NICOLE NATALIE
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:NATALIE
Last Name:RANAHAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NICOLE
Other - Middle Name:NATALIE
Other - Last Name:DEL RIO-NOBILI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2220 GLADSTONE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5123
Mailing Address - Country:US
Mailing Address - Phone:925-635-2978
Mailing Address - Fax:925-432-0886
Practice Address - Street 1:2220 GLADSTONE DR STE 3
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5123
Practice Address - Country:US
Practice Address - Phone:925-635-2978
Practice Address - Fax:925-432-0886
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily