Provider Demographics
NPI:1134303944
Name:FACIANE, RONDA MARIE (RN)
Entity Type:Individual
Prefix:MS
First Name:RONDA
Middle Name:MARIE
Last Name:FACIANE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7480 WATERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:LA
Mailing Address - Zip Code:71033-3366
Mailing Address - Country:US
Mailing Address - Phone:318-938-8204
Mailing Address - Fax:
Practice Address - Street 1:501 E STONER AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4242
Practice Address - Country:US
Practice Address - Phone:318-429-5794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN068077163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care