Provider Demographics
NPI:1275207482
Name:ATIENZA, RONALYN IVY ALINDAYU (RN-BC)
Entity Type:Individual
Prefix:
First Name:RONALYN IVY
Middle Name:ALINDAYU
Last Name:ATIENZA
Suffix:
Gender:F
Credentials:RN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2134-1 CORAL COURT
Mailing Address - Street 2:
Mailing Address - City:KAYENTA
Mailing Address - State:AZ
Mailing Address - Zip Code:86033
Mailing Address - Country:US
Mailing Address - Phone:928-612-0744
Mailing Address - Fax:
Practice Address - Street 1:KAYENTA HEALTH CENTER
Practice Address - Street 2:HWY 160 MP 394.3
Practice Address - City:KAYENTA
Practice Address - State:AZ
Practice Address - Zip Code:86033
Practice Address - Country:US
Practice Address - Phone:928-697-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU2019034650163WM0705X
GURE1955163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical