Provider Demographics
NPI:1558756171
Name:RONAN, AMY KATHERINE
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:KATHERINE
Last Name:RONAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 W GLENN AVE
Mailing Address - Street 2:APT A
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-7604
Mailing Address - Country:US
Mailing Address - Phone:334-414-0324
Mailing Address - Fax:
Practice Address - Street 1:805 W GLENN AVE
Practice Address - Street 2:APT A
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-7604
Practice Address - Country:US
Practice Address - Phone:334-414-0324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS10808390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program