Healthcare Provider Details

I. General information

NPI: 1215227707
Provider Name (Legal Business Name): RHONDA RAE MICHELENA R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2011
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 LONG DR SUITE C
SHERIDAN WY
82801-3282
US

IV. Provider business mailing address

909 LONG DR SUITE C
SHERIDAN WY
82801-3282
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-8958
  • Fax:
Mailing address:
  • Phone: 307-672-8958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9527
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: