Provider Demographics
NPI:1871617142
Name:RAY, NIRA L (MHS, PA-C)
Entity type:Individual
Prefix:MS
First Name:NIRA
Middle Name:L
Last Name:RAY
Suffix:
Gender:F
Credentials:MHS, PA-C
Other - Prefix:MS
Other - First Name:NIRA
Other - Middle Name:L
Other - Last Name:HINCKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MHS, PA-C
Mailing Address - Street 1:911 LAKEVILLE ST # 352
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3329
Mailing Address - Country:US
Mailing Address - Phone:415-754-5584
Mailing Address - Fax:
Practice Address - Street 1:24 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-6077
Practice Address - Country:US
Practice Address - Phone:203-739-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CT6639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P35496Medicare UPIN