Individual
MARY THERESA RONAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, BSN
Contact information
Practice address
2763 W LAKE DR, KIMBALL, MI 48074-4603
(810) 984-8576
Mailing address
2763 W LAKE DR, KIMBALL, MI 48074-4603
(810) 984-8576
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
4704208728
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704208728
DEPARTMENT OF COMMUNITY HEALTH - REGISTERED NURSE LICENSE
MI
Enumeration date
06/02/2011
Last updated
06/02/2011
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