Provider Demographics
NPI:1619184041
Name:WHITNEY, RONALD JAMES (EMT)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JAMES
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:FLIP
Other - Middle Name:J
Other - Last Name:WHITNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:EMT
Mailing Address - Street 1:1 COLVILLE STREET
Mailing Address - Street 2:
Mailing Address - City:NESPELEM
Mailing Address - State:WA
Mailing Address - Zip Code:99155
Mailing Address - Country:US
Mailing Address - Phone:509-634-2727
Mailing Address - Fax:509-634-2781
Practice Address - Street 1:1 COLVILLE STREET
Practice Address - Street 2:
Practice Address - City:NESPELEM
Practice Address - State:WA
Practice Address - Zip Code:99155
Practice Address - Country:US
Practice Address - Phone:509-634-2727
Practice Address - Fax:509-634-2781
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1170908146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9545807Medicaid