Provider Demographics
NPI:1760401368
Name:SEARS, RHONDALYNN J (NP)
Entity Type:Individual
Prefix:
First Name:RHONDALYNN
Middle Name:J
Last Name:SEARS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 GLENDALE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-3767
Mailing Address - Country:US
Mailing Address - Phone:219-462-0555
Mailing Address - Fax:
Practice Address - Street 1:1101 GLENDALE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3767
Practice Address - Country:US
Practice Address - Phone:219-462-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28110137A163W00000X
IN71000484A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200190160Medicaid
IN000000320720OtherANTHEM
IN000000721670OtherANTHEM TRADITIONAL
IN200190160Medicaid
IN000000320720OtherANTHEM