Provider Demographics
NPI:1558812610
Name:BLACKSON, RONDA (RN)
Entity Type:Individual
Prefix:MS
First Name:RONDA
Middle Name:
Last Name:BLACKSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:RONDA
Other - Middle Name:
Other - Last Name:BLACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2727 RHAWN ST APT 36B
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-3456
Mailing Address - Country:US
Mailing Address - Phone:267-683-9482
Mailing Address - Fax:
Practice Address - Street 1:2250 HICKORY RD
Practice Address - Street 2:SUITE 240
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1047
Practice Address - Country:US
Practice Address - Phone:610-684-4534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA547040RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse