Provider Demographics
NPI:1851513725
Name:RONK, MELODY ELAINE (PA-C)
Entity Type:Individual
Prefix:
First Name:MELODY
Middle Name:ELAINE
Last Name:RONK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13435 BUENA VISTA
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908
Mailing Address - Country:US
Mailing Address - Phone:719-495-4910
Mailing Address - Fax:
Practice Address - Street 1:4190 E WOODMEN RD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-8075
Practice Address - Country:US
Practice Address - Phone:719-265-6464
Practice Address - Fax:719-265-6750
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant