Basic Information
Provider Information
NPI: 1467463208
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: POPLYK
FirstName: RON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 406 S 30TH AVE
Address2: SUITE 202
City: YAKIMA
State: WA
PostalCode: 989023713
CountryCode: US
TelephoneNumber: 5099721051
FaxNumber: 5099724166
Practice Location
Address1: 406 S 30TH AVE
Address2: SUITE 202
City: YAKIMA
State: WA
PostalCode: 989023713
CountryCode: US
TelephoneNumber: 5099721051
FaxNumber: 5099724166
Other Information
ProviderEnumerationDate: 08/10/2006
LastUpdateDate: 03/24/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X264805-4406UTN Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 
367500000XAP60207660WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

ID Information
IDTypeStateIssuerDescription
19024610001UTDEPT OF LABOROTHER
26652301UTALTIUSOTHER
6829501UTPEHPOTHER
QMP0000033680101UTMOLINAOTHER
7890001UTHEALTHY UOTHER
731714968RRN01UTEDUCATORS MUTUALOTHER


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