Provider Demographics
NPI:1053548214
Name:MILLER-ERNEST, RONDA JOY (NURSE PRACTITIONER)
Entity type:Individual
Prefix:DR
First Name:RONDA
Middle Name:JOY
Last Name:MILLER-ERNEST
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:508 E SOUTH TEMPLE
Mailing Address - Street 2:310
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1013
Mailing Address - Country:US
Mailing Address - Phone:801-355-4316
Mailing Address - Fax:801-355-6267
Practice Address - Street 1:508 E SOUTH TEMPLE
Practice Address - Street 2:310
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1013
Practice Address - Country:US
Practice Address - Phone:801-355-4316
Practice Address - Fax:801-355-6267
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT198426-4405363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics