Provider Demographics
NPI:1063815371
Name:PONCE, LURDES (RN)
Entity type:Individual
Prefix:MRS
First Name:LURDES
Middle Name:
Last Name:PONCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 OLD COWICHE RD
Mailing Address - Street 2:
Mailing Address - City:COWICHE
Mailing Address - State:WA
Mailing Address - Zip Code:98923-9705
Mailing Address - Country:US
Mailing Address - Phone:509-678-5509
Mailing Address - Fax:
Practice Address - Street 1:2205 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-2437
Practice Address - Country:US
Practice Address - Phone:509-457-6540
Practice Address - Fax:509-469-2185
Is Sole Proprietor?:No
Enumeration Date:2014-09-30
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60098614163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health