Provider Demographics
NPI:1720615321
Name:VARDY, RONIE DANA
Entity Type:Individual
Prefix:
First Name:RONIE
Middle Name:DANA
Last Name:VARDY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6852 INDIAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:LONG GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60047-5110
Mailing Address - Country:US
Mailing Address - Phone:847-287-3747
Mailing Address - Fax:
Practice Address - Street 1:6852 INDIAN CREEK RD
Practice Address - Street 2:
Practice Address - City:LONG GROVE
Practice Address - State:IL
Practice Address - Zip Code:60047-5110
Practice Address - Country:US
Practice Address - Phone:847-287-3747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-24
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant