Basic Information
Provider Information
NPI: 1003142589
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RONDEAU
FirstName: STEVEN
MiddleName: P
NamePrefix: DR.
NameSuffix:  
Credential: ND
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2620 E PROSPECT RD
Address2: SUITE# 190
City: FORT COLLINS
State: CO
PostalCode: 805259098
CountryCode: US
TelephoneNumber: 9702211106
FaxNumber: 9702321050
Practice Location
Address1: 2620 E PROSPECT RD
Address2: SUITE# 190
City: FORT COLLINS
State: CO
PostalCode: 805259098
CountryCode: US
TelephoneNumber: 9702211106
FaxNumber: 9702321050
Other Information
ProviderEnumerationDate: 10/19/2009
LastUpdateDate: 10/15/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
175F00000X0090069148VTY Other Service ProvidersNaturopath 

No ID Information.


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