Individual
KYLE JOSEPH RONNAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
1672 S WOODSAGE AVENUE, SUITE #120, MERIDIAN, ID 83642
(208) 515-2273
(208) 515-2274
Mailing address
1672 S WOODSAGE AVENUE, SUITE #120, MERIDIAN, ID 83642
(208) 515-2273
(208) 525-2274
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
55936
ID
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
55936
ID
390200000X
Student in an Organized Health Care Education/Training Program
RN-41181
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55936
IDAHO STATE BOARD OF NURSING
ID
Enumeration date
01/10/2017
Last updated
02/21/2022
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