Provider Demographics
NPI:1609145564
Name:KMIECIK, RONALD MATTHEW (PAC)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:MATTHEW
Last Name:KMIECIK
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2540 N HEALTHY WAY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2315
Mailing Address - Country:US
Mailing Address - Phone:402-727-1091
Mailing Address - Fax:402-727-7268
Practice Address - Street 1:2560 N HEALTHY WAY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2315
Practice Address - Country:US
Practice Address - Phone:402-941-5073
Practice Address - Fax:402-727-7628
Is Sole Proprietor?:No
Enumeration Date:2011-12-22
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1854363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant