Healthcare Provider Details

I. General information

NPI: 1033515895
Provider Name (Legal Business Name): RONDA ORNDOFF NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RONDA WANTLAND NP

II. Dates (important events)

Enumeration Date: 11/06/2014
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 N GRAND AVE
PUEBLO CO
81003-3111
US

IV. Provider business mailing address

415 N GRAND AVE
PUEBLO CO
81003-3111
US

V. Phone/Fax

Practice location:
  • Phone: 719-664-2014
  • Fax: 833-438-9307
Mailing address:
  • Phone: 719-664-2014
  • Fax: 833-438-9307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0991503
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0991503
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: