Healthcare Provider Details

I. General information

NPI: 1265513451
Provider Name (Legal Business Name): RONNIE OKIALDA PNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 76TH ST NE
MARYSVILLE WA
98270-3726
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 360-651-7492
  • Fax: 360-651-7482
Mailing address:
  • Phone: 206-860-5414
  • Fax: 206-720-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP30007421
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: