Provider Demographics
NPI:1730465832
Name:SMORONG, RHONDA E (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:E
Last Name:SMORONG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17421 W MOHAVE ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1711
Mailing Address - Country:US
Mailing Address - Phone:623-606-2790
Mailing Address - Fax:
Practice Address - Street 1:16066 N PARKVIEW PL
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-7461
Practice Address - Country:US
Practice Address - Phone:623-523-8690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP047617164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse