Provider Demographics
NPI:1366202814
Name:KING, RONETTE LASHELL
Entity type:Individual
Prefix:
First Name:RONETTE
Middle Name:LASHELL
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 CLEVELAND AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-1740
Mailing Address - Country:US
Mailing Address - Phone:681-404-8111
Mailing Address - Fax:
Practice Address - Street 1:788 CLEVELAND AVE APT 202
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-1740
Practice Address - Country:US
Practice Address - Phone:681-404-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant