Provider Demographics
NPI:1922605229
Name:KENAN, RONALD (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:KENAN
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 SHEWSBURY AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-2414
Mailing Address - Country:US
Mailing Address - Phone:808-222-8431
Mailing Address - Fax:
Practice Address - Street 1:533 SHEWSBURY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-2414
Practice Address - Country:US
Practice Address - Phone:808-222-8431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital