Provider Demographics
NPI:1154303667
Name:RAVANI, RHONDA JO (ARNP)
Entity type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:JO
Last Name:RAVANI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 116TH AVE NE
Mailing Address - Street 2:#500
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-4623
Mailing Address - Country:US
Mailing Address - Phone:425-454-3938
Mailing Address - Fax:425-454-2568
Practice Address - Street 1:450 NW GILMAN BLVD
Practice Address - Street 2:#203
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2483
Practice Address - Country:US
Practice Address - Phone:425-454-3938
Practice Address - Fax:425-837-1460
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004254174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9621525Medicaid
WA121963OtherLABOR & INDUSTRIES
WAAB03456Medicare ID - Type Unspecified
WA9621525Medicaid