Provider Demographics
NPI:1356690267
Name:RONEY, JOANNE MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:MARIE
Last Name:RONEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:JOANNE
Other - Middle Name:MARIE
Other - Last Name:MICKLEBOROUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1890 SILVER CROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9524
Mailing Address - Country:US
Mailing Address - Phone:815-300-7785
Mailing Address - Fax:815-300-5991
Practice Address - Street 1:1890 SILVER CROSS BLVD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9524
Practice Address - Country:US
Practice Address - Phone:815-300-7785
Practice Address - Fax:815-300-5991
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2022-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006567363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics