MEDICARE: HEIDI MARIE RONNFELDT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider

General Provider Information

NPI Number	:	1376612010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI MARIE RONNFELDT

Provider Business Mailing Address
First Line	:	400 SAND ISLAND PKWY
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96819-4326
Country	:	US
Telephone Number	:	808-433-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 SAND ISLAND PKWY
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96819-4326
Country	:	US
Telephone Number	:	808-433-9800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	11/13/2008

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Directions to “ HEIDI MARIE RONNFELDT ” Practice Location

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