Provider Demographics
NPI:1588651244
Name:NIEMI JUDGE, RHONDA S (NPC)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:S
Last Name:NIEMI JUDGE
Suffix:
Gender:F
Credentials:NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-4820
Mailing Address - Country:US
Mailing Address - Phone:262-652-1474
Mailing Address - Fax:
Practice Address - Street 1:3710 57TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-4820
Practice Address - Country:US
Practice Address - Phone:262-652-1474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2797-33363LF0000X
WI2797-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39-1805927Medicaid