Provider Demographics
NPI:1699914911
Name:SHAFFNER, RONDA KAY (LPN)
Entity type:Individual
Prefix:MRS
First Name:RONDA
Middle Name:KAY
Last Name:SHAFFNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 SUMMIT CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1136
Mailing Address - Country:US
Mailing Address - Phone:937-622-1592
Mailing Address - Fax:
Practice Address - Street 1:1668 SUMMIT CREEK DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-1136
Practice Address - Country:US
Practice Address - Phone:937-622-1592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN133164164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPN133164OtherLPN