Provider Demographics
NPI:1639223191
Name:BENNETT, RONDA ROSITA (RN)
Entity Type:Individual
Prefix:MS
First Name:RONDA
Middle Name:ROSITA
Last Name:BENNETT
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 1:1713 SUN GLO DR
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-4243
Mailing Address - Country:US
Mailing Address - Phone:154-147-4021
Mailing Address - Fax:
Practice Address - Street 1:1713 SUN GLO DR
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-4243
Practice Address - Country:US
Practice Address - Phone:154-147-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health