Healthcare Provider Details

I. General information

NPI: 1083855563
Provider Name (Legal Business Name): RONALD SCOTT MUNN CCP, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2009
Last Update Date: 03/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PHILADELPHIA DR SUITE 301
DAYTON OH
45406-1840
US

IV. Provider business mailing address

2200 PHILADELPHIA DR SUITE 301
DAYTON OH
45406-1840
US

V. Phone/Fax

Practice location:
  • Phone: 937-279-9777
  • Fax: 937-279-9332
Mailing address:
  • Phone: 937-279-9777
  • Fax: 937-279-9332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-197689
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: