Healthcare Provider Details

I. General information

NPI: 1912443839
Provider Name (Legal Business Name): MICHAEL CHARLES RONDEAU N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 W COLLEGE AVE
MARQUETTE MI
49855-2736
US

IV. Provider business mailing address

580 W COLLEGE AVE
MARQUETTE MI
49855-2736
US

V. Phone/Fax

Practice location:
  • Phone: 906-228-9440
  • Fax:
Mailing address:
  • Phone: 906-228-9440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704246718
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4704246718
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704246718
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number4704246718
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: