Provider Demographics
NPI:1467979625
Name:WILSON, RONDA JEAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:RONDA
Middle Name:JEAN
Last Name:WILSON
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 1:10 PARK PL FL 1
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1507
Mailing Address - Country:US
Mailing Address - Phone:518-779-3844
Mailing Address - Fax:
Practice Address - Street 1:10 PARK PL FL 1
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-1507
Practice Address - Country:US
Practice Address - Phone:518-779-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY327466164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse