Provider Demographics
NPI:1932854213
Name:DIVINAGRACIA, RONA BALICAS (APRN, PMHNP-BC, CCM)
Entity type:Individual
Prefix:
First Name:RONA
Middle Name:BALICAS
Last Name:DIVINAGRACIA
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC, CCM
Other - Prefix:
Other - First Name:RONA
Other - Middle Name:S
Other - Last Name:BALICAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 POTTERY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3768
Mailing Address - Country:US
Mailing Address - Phone:360-895-5000
Mailing Address - Fax:877-516-9023
Practice Address - Street 1:1400 POTTERY AVE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3711
Practice Address - Country:US
Practice Address - Phone:360-895-5000
Practice Address - Fax:877-516-9023
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN85093163W00000X
NV867980363LP0808X
WAAP61575192363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse