Provider Demographics
NPI:1205049004
Name:HARRIS, RONDA LEE (RN LMT)
Entity type:Individual
Prefix:MS
First Name:RONDA
Middle Name:LEE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN LMT
Other - Prefix:
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Mailing Address - Street 1:2913 INGERSOLL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-4014
Mailing Address - Country:US
Mailing Address - Phone:515-710-5930
Mailing Address - Fax:515-274-8732
Practice Address - Street 1:2913 INGERSOLL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-4014
Practice Address - Country:US
Practice Address - Phone:515-710-5930
Practice Address - Fax:515-274-8732
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00999225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA00999OtherIA DEPT PUBLIC HEALTH