Provider Demographics
NPI:1992467393
Name:POWERS, RONDA JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:JEAN
Last Name:POWERS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:RONDA
Other - Middle Name:JEAN
Other - Last Name:WALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:788 8TH AVE SE STE 400
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-2108
Mailing Address - Country:US
Mailing Address - Phone:319-440-2625
Mailing Address - Fax:319-398-6649
Practice Address - Street 1:788 8TH AVE SE STE 400
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-2108
Practice Address - Country:US
Practice Address - Phone:319-440-2625
Practice Address - Fax:319-398-6649
Is Sole Proprietor?:No
Enumeration Date:2021-10-13
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAP38995164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse