Provider Demographics
NPI:1396453007
Name:RAMIREZ, ADRIAN WILSON
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:WILSON
Last Name:RAMIREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 CHEYENNE TRL
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72762-2245
Mailing Address - Country:US
Mailing Address - Phone:956-534-1046
Mailing Address - Fax:
Practice Address - Street 1:1115 CHEYENNE TRL
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-2245
Practice Address - Country:US
Practice Address - Phone:956-534-1046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR016531401564376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide