Provider Demographics
NPI:1619270592
Name:RONHOVDEE, KIMBERLY JOYCE
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOYCE
Last Name:RONHOVDEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 OREGON TRAIL PL
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-5657
Mailing Address - Country:US
Mailing Address - Phone:503-545-4835
Mailing Address - Fax:
Practice Address - Street 1:696 5TH ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-2308
Practice Address - Country:US
Practice Address - Phone:503-545-4835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID92365367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered