Provider Demographics
NPI:1235904699
Name:PAGNING, RONI DILANE
Entity Type:Individual
Prefix:
First Name:RONI DILANE
Middle Name:
Last Name:PAGNING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 3RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040-7454
Mailing Address - Country:US
Mailing Address - Phone:301-809-7611
Mailing Address - Fax:
Practice Address - Street 1:1000 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:ISANTI
Practice Address - State:MN
Practice Address - Zip Code:55040-7454
Practice Address - Country:US
Practice Address - Phone:301-809-7611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)