Provider Demographics
NPI:1639385388
Name:JORGENSEN, RHONDA R
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:R
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:R
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:745 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-2677
Mailing Address - Country:US
Mailing Address - Phone:605-842-7100
Mailing Address - Fax:
Practice Address - Street 1:745 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2677
Practice Address - Country:US
Practice Address - Phone:605-842-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR015827367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100251288-00Medicaid
SD4995588OtherWELMARK BCBS OF SD
NE100251288-00Medicaid