Provider Demographics
NPI:1245642024
Name:OWENS-DEHMER, RONDA (NP)
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:
Last Name:OWENS-DEHMER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14074 TRADE CENTER DR STE 127
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-4568
Mailing Address - Country:US
Mailing Address - Phone:317-779-2947
Mailing Address - Fax:317-981-1714
Practice Address - Street 1:14074 TRADE CENTER DR STE 127
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-4568
Practice Address - Country:US
Practice Address - Phone:317-358-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004947A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201235130Medicaid
IN201235130Medicaid