| Doctor Name: | RONDA WANTLAND |
| NPI Number: | 1033515895 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | 0991503 |
| Business Practice Address: | 3670 Parker Blvd 101 Pueblo, CO - 810082285 |
| Business Phone Number: | 7195641544 |
| Business Fax Number: | |
| Mailing Address: | 3670 Parker Blvd, 101 PUEBLO |
| State: | CO |
| Postal Code: | 810082285 |
| Phone Number: | 7195641544 |
| Fax Number: | |
| NPI Enumeration Date: | 11/06/2014 |
| NPI Last Update Date: | 04/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0991503 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |