Basic Information
Provider Information
NPI: 1578736989
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: RAMIREZ
FirstName: RHONDA
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: SURGICAL TECH
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 420 E DIVISION ST
Address2:  
City: FOND DU LAC
State: WI
PostalCode: 549354560
CountryCode: US
TelephoneNumber: 9209268340
FaxNumber: 9209268370
Practice Location
Address1: 421 CAMELOT DR
Address2:  
City: FOND DU LAC
State: WI
PostalCode: 549358335
CountryCode: US
TelephoneNumber: 9209268616
FaxNumber: 9209268098
Other Information
ProviderEnumerationDate: 04/07/2008
LastUpdateDate: 07/22/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
246ZS0410X WIN    
246ZS0410X  Y    

No ID Information.


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