Provider Demographics
NPI:1881367456
Name:OMARI, RONALD N (CNP)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:N
Last Name:OMARI
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11931 BLUE SPRUCE CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:MN
Mailing Address - Zip Code:55327-4101
Mailing Address - Country:US
Mailing Address - Phone:763-639-3356
Mailing Address - Fax:
Practice Address - Street 1:11931 BLUE SPRUCE CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:MN
Practice Address - Zip Code:55327-4101
Practice Address - Country:US
Practice Address - Phone:763-639-3356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-29
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8285363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health