Provider Demographics
NPI:1043724834
Name:DAVIS-MINNICK, RONDA
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:
Last Name:DAVIS-MINNICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 ELM ST STE 1200
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-2675
Mailing Address - Country:US
Mailing Address - Phone:320-763-6018
Mailing Address - Fax:
Practice Address - Street 1:10 E HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:MN
Practice Address - Zip Code:56267-1176
Practice Address - Country:US
Practice Address - Phone:320-763-6018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR201625-4163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health