Provider Demographics
NPI:1992280028
Name:FRANK, RONDA
Entity type:Individual
Prefix:
First Name:RONDA
Middle Name:
Last Name:FRANK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2583 KAMM RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:13110-3119
Mailing Address - Country:US
Mailing Address - Phone:315-415-0638
Mailing Address - Fax:
Practice Address - Street 1:2583 KAMM RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:NY
Practice Address - Zip Code:13110-3119
Practice Address - Country:US
Practice Address - Phone:315-415-0638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282040164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$Medicaid