Basic Information
| Provider Information | |||||||||
| NPI: | 1104018589 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RATTANAKORN | ||||||||
| FirstName: | URAIRONG | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14001 NW 4TH ST | ||||||||
| Address2: | #202 | ||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330282297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543919687 | ||||||||
| FaxNumber: | 9543919687 | ||||||||
| Practice Location | |||||||||
| Address1: | 14001 NW 4TH ST | ||||||||
| Address2: | #202 | ||||||||
| City: | PEMBROKE PINES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330282297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543919687 | ||||||||
| FaxNumber: | 9543919687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2007 | ||||||||
| LastUpdateDate: | 02/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 3159562 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.