Provider Demographics
NPI:1609510114
Name:SMOLIK, RONNIE BROOKE (RN)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:BROOKE
Last Name:SMOLIK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8789 S HIGHLAND DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-1603
Mailing Address - Country:US
Mailing Address - Phone:801-943-3260
Mailing Address - Fax:
Practice Address - Street 1:6154 W CEDAR HILL RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-3118
Practice Address - Country:US
Practice Address - Phone:801-891-6987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11487968-3102163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical