Provider Demographics
NPI:1932470846
Name:RONAN, ANDREA L (MS, RD, CNSC, CD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:RONAN
Suffix:
Gender:F
Credentials:MS, RD, CNSC, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1281 NE BIG BERRY LOOP
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-7007
Mailing Address - Country:US
Mailing Address - Phone:814-880-0538
Mailing Address - Fax:
Practice Address - Street 1:1281 NE BIG BERRY LOOP
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-7007
Practice Address - Country:US
Practice Address - Phone:814-880-0538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN004627133V00000X
MDDX3531133V00000X
WADI61105202133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered