Provider Demographics
NPI:1437437852
Name:MOORE-WATSON, RONDA GINEAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:RONDA
Middle Name:GINEAN
Last Name:MOORE-WATSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 GREENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1422
Mailing Address - Country:US
Mailing Address - Phone:845-791-6545
Mailing Address - Fax:
Practice Address - Street 1:2 GREENVIEW AVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1422
Practice Address - Country:US
Practice Address - Phone:845-791-6545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-02
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229140-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse