Provider Demographics
NPI:1871944249
Name:WHITE, RONDA R (11/19/1971)
Entity type:Individual
Prefix:MRS
First Name:RONDA
Middle Name:R
Last Name:WHITE
Suffix:
Gender:F
Credentials:11/19/1971
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404-1317
Mailing Address - Country:US
Mailing Address - Phone:616-299-9801
Mailing Address - Fax:
Practice Address - Street 1:17 RIVER ST
Practice Address - Street 2:
Practice Address - City:COOPERSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49404-1317
Practice Address - Country:US
Practice Address - Phone:616-299-9801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other