Provider Demographics
NPI:1053825398
Name:COOK, RONDA NICHELLE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MISS
First Name:RONDA
Middle Name:NICHELLE
Last Name:COOK
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 E PALOMAR ST UNIT 1416
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6987
Mailing Address - Country:US
Mailing Address - Phone:405-882-6612
Mailing Address - Fax:
Practice Address - Street 1:825 E PALOMAR ST UNIT 1416
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6987
Practice Address - Country:US
Practice Address - Phone:405-882-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95111652163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse