Provider Demographics
NPI:1457838286
Name:KHAN, RONITA (RN)
Entity Type:Individual
Prefix:
First Name:RONITA
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 S LAMAR ST APT 307
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75215-6819
Mailing Address - Country:US
Mailing Address - Phone:214-794-8060
Mailing Address - Fax:
Practice Address - Street 1:1409 S LAMAR ST APT 307
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-6819
Practice Address - Country:US
Practice Address - Phone:214-794-8060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041399798163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent