Basic Information
| Provider Information | |||||||||
| NPI: | 1821042375 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RATKAY | ||||||||
| FirstName: | RONNIE | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 541 OTIS BOWEN DR | ||||||||
| Address2: | |||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463214158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199345300 | ||||||||
| FaxNumber: | 2199345389 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 W 89TH AVE | ||||||||
| Address2: | |||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464106254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197575275 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 09/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 28065161A | IN | N | Nursing Service Providers | Registered Nurse | 367500000X | 28065161A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 000000273367 | 01 | IN | ANTHEM | OTHER | 200152290 | 05 | IN | MEDICAID | P00015469 | 01 | IN | RR MEDICARE | OTHER |