Basic Information
| Provider Information | |||||||||
| NPI: | 1528138468 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMPSON | ||||||||
| FirstName: | RONDA | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1639A 293RD AVE | ||||||||
| Address2: | |||||||||
| City: | FREDERIC | ||||||||
| State: | WI | ||||||||
| PostalCode: | 548373807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154722291 | ||||||||
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| Practice Location | |||||||||
| Address1: | 235 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | SAINT CROIX FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 540244117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7154833261 | ||||||||
| FaxNumber: | 7154830380 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 09/30/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LG0600X | R146582-2 | MN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology | 363LG0600X | 4414-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Gerontology |
ID Information
| ID | Type | State | Issuer | Description | 0716183 | 05 | IA | MEDICAID | 1028026 | 01 | PREFERREDONE | OTHER | 165135800 | 05 | MN | MEDICAID | 43951500 | 05 | WI | MEDICAID | 04-05876 | 01 | MEDICA PRIMARY | OTHER | 151373 | 01 | UCARE | OTHER | 1345966 | 01 | ARAZ | OTHER | HP34227 | 01 | HEALTHPARTNERS | OTHER | 04-07844 | 01 | MEDICA CHOICE | OTHER | 502K8TH | 01 | BLUE CROSS BLUE SHIELD | OTHER |