Provider Demographics
NPI:1013974369
Name:WING, RONNIE JAY (CRNA)
Entity Type:Individual
Prefix:
First Name:RONNIE
Middle Name:JAY
Last Name:WING
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 S COOLIDGE ST
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1872
Mailing Address - Country:US
Mailing Address - Phone:509-793-9715
Mailing Address - Fax:509-764-3244
Practice Address - Street 1:1775 BROWNING WAY STE 102
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-8338
Practice Address - Country:US
Practice Address - Phone:775-299-4555
Practice Address - Fax:775-525-5257
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61066966367500000X
NVCRNA000228367500000X
NV824627363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002404030Medicaid
WA2157457Medicaid
NVP00003556OtherPALMETTO GBA