Provider Demographics
NPI:1568969871
Name:LAO-WILSON, RONNA (MD)
Entity Type:Individual
Prefix:
First Name:RONNA
Middle Name:
Last Name:LAO-WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4502
Mailing Address - Country:US
Mailing Address - Phone:775-328-9220
Mailing Address - Fax:775-328-9496
Practice Address - Street 1:190 W 6TH ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4502
Practice Address - Country:US
Practice Address - Phone:775-328-9220
Practice Address - Fax:775-328-9496
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-12
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV21437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty