Healthcare Provider Details

I. General information

NPI: 1932164738
Provider Name (Legal Business Name): RONDA LEA KAMAHELE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 24A VAMHCS PERRY POINT DIVISION
PERRY POINT MD
21902-1100
US

IV. Provider business mailing address

39 CRESTWOOD DR
ELKTON MD
21921-7440
US

V. Phone/Fax

Practice location:
  • Phone: 410-642-2411
  • Fax: 410-642-1872
Mailing address:
  • Phone: 410-620-2238
  • Fax: 410-642-1872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR091867
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: