Healthcare Provider Details

I. General information

NPI: 1356434914
Provider Name (Legal Business Name): RON L HONEYMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 32ND AVE S
FARGO ND
58103-6132
US

IV. Provider business mailing address

PO BOX 6001
FARGO ND
58108-6001
US

V. Phone/Fax

Practice location:
  • Phone: 701-364-8000
  • Fax: 701-364-8078
Mailing address:
  • Phone: 701-364-3300
  • Fax: 701-364-8906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR30027
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: