Provider Demographics
NPI:1902152911
Name:OCONNELL, RONDA INGA (ANP-BC)
Entity Type:Individual
Prefix:MS
First Name:RONDA
Middle Name:INGA
Last Name:OCONNELL
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 RIBAUT RD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5472
Mailing Address - Country:US
Mailing Address - Phone:843-522-7605
Mailing Address - Fax:843-522-7612
Practice Address - Street 1:989 RIBAUT RD
Practice Address - Street 2:SUITE 260
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5472
Practice Address - Country:US
Practice Address - Phone:843-522-7605
Practice Address - Fax:843-522-7612
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17940 RX363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC1851605Medicare PIN