Provider Demographics
NPI:1225534613
Name:MAVUNGA, RONALD (LPN)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:MAVUNGA
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 N BEND DR
Mailing Address - Street 2:
Mailing Address - City:PATASKALA
Mailing Address - State:OH
Mailing Address - Zip Code:43062-7552
Mailing Address - Country:US
Mailing Address - Phone:614-516-6548
Mailing Address - Fax:
Practice Address - Street 1:297 N BEND DR
Practice Address - Street 2:
Practice Address - City:PATASKALA
Practice Address - State:OH
Practice Address - Zip Code:43062-7552
Practice Address - Country:US
Practice Address - Phone:614-516-6548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.160297.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse