Provider Demographics
NPI:1063461507
Name:DOCKTER JOLLIFFE, RHONDA D (MSN, ARNP, FNP)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:D
Last Name:DOCKTER JOLLIFFE
Suffix:
Gender:F
Credentials:MSN, ARNP, FNP
Other - Prefix:MS
Other - First Name:RHONDA
Other - Middle Name:D
Other - Last Name:DOCKTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 GATEWAY AVENUE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501
Mailing Address - Country:US
Mailing Address - Phone:701-751-3271
Mailing Address - Fax:
Practice Address - Street 1:1001 GATEWAY AVENUE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501
Practice Address - Country:US
Practice Address - Phone:701-751-3271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR22950363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND25214OtherBCBS ND NUMBER
ND19587Medicaid
NDN711342OtherMEDICARE GROUP NUMBER
ND13425OtherMEDICAID GROUP NUMBER
NDN711342OtherMEDICARE GROUP NUMBER
NDS48039Medicare UPIN
NDN711949Medicare PIN