Provider Demographics
NPI:1467463208
Name:POPLYK, RON (CRNA)
Entity Type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:POPLYK
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 S 30TH AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3713
Mailing Address - Country:US
Mailing Address - Phone:509-972-1051
Mailing Address - Fax:509-972-4166
Practice Address - Street 1:406 S 30TH AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3713
Practice Address - Country:US
Practice Address - Phone:509-972-1051
Practice Address - Fax:509-972-4166
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT264805-4406367500000X
WAAP60207660367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT190246100OtherDEPT OF LABOR
UT266523OtherALTIUS
UT68295OtherPEHP
UTQMP00000336801OtherMOLINA
UT78900OtherHEALTHY U
UT731714968RRNOtherEDUCATORS MUTUAL
UT78900OtherHEALTHY U
UTQMP00000336801OtherMOLINA
UT266523OtherALTIUS