Provider Demographics
NPI:1558991547
Name:PATEL, RONAK RAJESHKUMAR (RN)
Entity Type:Individual
Prefix:
First Name:RONAK
Middle Name:RAJESHKUMAR
Last Name:PATEL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 DAY FLOWER CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6110
Mailing Address - Country:US
Mailing Address - Phone:573-999-9209
Mailing Address - Fax:
Practice Address - Street 1:3710 S LENOIR ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-5463
Practice Address - Country:US
Practice Address - Phone:573-876-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-19
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017034108163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty