Basic Information
Provider Information
NPI: 1235377516
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALBRECHT
FirstName: RONDA
MiddleName: KAY
NamePrefix:  
NameSuffix:  
Credential: M.S.N., ACNP-BC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 900 E MICHIGAN AVE
Address2:  
City: JACKSON
State: MI
PostalCode: 492012457
CountryCode: US
TelephoneNumber: 1517782122
FaxNumber: 5177821223
Practice Location
Address1: 900 E MICHIGAN AVE STE 105
Address2:  
City: JACKSON
State: MI
PostalCode: 492012490
CountryCode: US
TelephoneNumber: 5177823190
FaxNumber: 5177821223
Other Information
ProviderEnumerationDate: 01/26/2009
LastUpdateDate: 06/29/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/29/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100X4704180918MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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