Provider Demographics
NPI:1093521544
Name:PONTON, RAVEN (CRNP)
Entity type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:PONTON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3572 BRODHEAD RD STE 301
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-3141
Mailing Address - Country:US
Mailing Address - Phone:878-439-7157
Mailing Address - Fax:878-439-7158
Practice Address - Street 1:3572 BRODHEAD RD STE 301
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-3141
Practice Address - Country:US
Practice Address - Phone:878-439-7157
Practice Address - Fax:878-439-7158
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily