Individual
SHELLY RONAYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-5155
(417) 875-3000
Mailing address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-5155
(417) 875-3000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1999137245
MO
363L00000X
Nurse Practitioner
Primary
2012002550
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023388220
—
MO
05
—
429543507
—
MO
Enumeration date
01/04/2012
Last updated
12/27/2018
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