=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285071480
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONG NONE SUN FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/29/2013
-----------------------------------------------------
Last Update Date | 11/19/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 PENNSYLVANIA AVE OTTUMWA REGIONAL HEALTH CENTER, EMERGENCY ROOM
-----------------------------------------------------
City | OTTUMWA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52501-6427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-684-2323
-----------------------------------------------------
Fax | 641-683-2888
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 PENNSYLVANIA AVE OTTUMWA REGIONAL HEALTH CENTER, EMERGENCY ROOM
-----------------------------------------------------
City | OTTUMWA
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 52501-6427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 641-684-2323
-----------------------------------------------------
Fax | 641-683-2888
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 041436577
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | A133590
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 2012042885
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------