Provider Demographics
NPI:1164007084
Name:FENN, RONA MAE R
Entity Type:Individual
Prefix:
First Name:RONA MAE
Middle Name:R
Last Name:FENN
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 1:7590 DEMONA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89123-1434
Mailing Address - Country:US
Mailing Address - Phone:702-470-4476
Mailing Address - Fax:
Practice Address - Street 1:7590 DEMONA DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-1434
Practice Address - Country:US
Practice Address - Phone:702-470-4476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider