Provider Demographics
NPI:1104402072
Name:KENNAMER, RONDA MARIE (CCP, LP)
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:MARIE
Last Name:KENNAMER
Suffix:
Gender:F
Credentials:CCP, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 DAYS END RD
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-9100
Mailing Address - Country:US
Mailing Address - Phone:832-573-2095
Mailing Address - Fax:
Practice Address - Street 1:2827 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4813
Practice Address - Country:US
Practice Address - Phone:210-705-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist