Provider Demographics
NPI:1053804120
Name:PINKERTON, RONI L (DNP)
Entity type:Individual
Prefix:
First Name:RONI
Middle Name:L
Last Name:PINKERTON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12702 WESTPORT PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68138
Mailing Address - Country:US
Mailing Address - Phone:402-502-5525
Mailing Address - Fax:402-343-1330
Practice Address - Street 1:12702 WESTPORT PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68138
Practice Address - Country:US
Practice Address - Phone:402-502-5525
Practice Address - Fax:402-343-1330
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE61195363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE112511OtherNURSE PRACTITIONER
NE61195OtherNURSING LICENSE