Healthcare Provider Details

I. General information

NPI: 1124784061
Provider Name (Legal Business Name): RONNETTA BLACKWELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RONNETTA DENTON

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N JAMES RD
COLUMBUS OH
43219-1834
US

IV. Provider business mailing address

2665 MELLOWBROOK ST
COLUMBUS OH
43232-4707
US

V. Phone/Fax

Practice location:
  • Phone: 614-257-5200
  • Fax:
Mailing address:
  • Phone: 614-702-6115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN.531792
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: