Provider Demographics
NPI:1588736706
Name:BACANI, RONALD C (NP-C, ACNS, MSN)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:C
Last Name:BACANI
Suffix:
Gender:M
Credentials:NP-C, ACNS, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 W 5TH ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-5034
Mailing Address - Country:US
Mailing Address - Phone:432-580-3775
Mailing Address - Fax:432-580-8310
Practice Address - Street 1:540 W 5TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-5034
Practice Address - Country:US
Practice Address - Phone:432-580-3775
Practice Address - Fax:432-580-8310
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX639134363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner