Provider Demographics
NPI:1558342907
Name:ROTERT, RHONDA C (PA-C)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:C
Last Name:ROTERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:CLARICE
Other - Last Name:MCCLELLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1215 DUFF AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-3014
Mailing Address - Country:US
Mailing Address - Phone:515-239-4422
Mailing Address - Fax:515-239-4574
Practice Address - Street 1:1215 DUFF AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-3014
Practice Address - Country:US
Practice Address - Phone:515-239-4422
Practice Address - Fax:515-239-4574
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01157363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAS76208Medicare UPIN
IA14711Medicare ID - Type Unspecified