Provider Demographics
NPI:1952434714
Name:PRONK, ADRIENNE ANISSA (CSA)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:ANISSA
Last Name:PRONK
Suffix:
Gender:F
Credentials:CSA
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Mailing Address - Street 1:6965 S OPAL DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85249-7221
Mailing Address - Country:US
Mailing Address - Phone:480-354-5562
Mailing Address - Fax:480-354-5562
Practice Address - Street 1:6965 S OPAL DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-7221
Practice Address - Country:US
Practice Address - Phone:480-354-5562
Practice Address - Fax:480-354-5562
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist