Provider Demographics
NPI:1215227707
Name:MICHELENA, RHONDA RAE (RN)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:RAE
Last Name:MICHELENA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 LONG DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3282
Mailing Address - Country:US
Mailing Address - Phone:307-672-8958
Mailing Address - Fax:
Practice Address - Street 1:909 LONG DR
Practice Address - Street 2:SUITE C
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3282
Practice Address - Country:US
Practice Address - Phone:307-672-8958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY9527163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse