Provider Demographics
NPI:1679611107
Name:DODD, RHONDA M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:M
Last Name:DODD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 171
Mailing Address - Street 2:311 KUHLMANN AVE.
Mailing Address - City:HATLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54440-0171
Mailing Address - Country:US
Mailing Address - Phone:715-297-2719
Mailing Address - Fax:
Practice Address - Street 1:209B W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-5443
Practice Address - Country:US
Practice Address - Phone:715-845-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42024500Medicaid