Healthcare Provider Details

I. General information

NPI: 1881792455
Provider Name (Legal Business Name): JAMES PATRICK RONAN ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9951 MICKELBERRY RD NW STE 101
SILVERDALE WA
98383-8309
US

IV. Provider business mailing address

1582 GULF RD UNIT 1309
POINT ROBERTS WA
98281-8059
US

V. Phone/Fax

Practice location:
  • Phone: 360-692-9362
  • Fax:
Mailing address:
  • Phone: 503-449-0293
  • Fax: 503-449-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number088006164N2 PNP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN091542 182
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60076323
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: