Provider Demographics
NPI:1285950147
Name:RONDOU, CECELIA (FNP, CNM)
Entity type:Individual
Prefix:
First Name:CECELIA
Middle Name:
Last Name:RONDOU
Suffix:
Gender:F
Credentials:FNP, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 SONOMA AVE STE 18
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4813
Mailing Address - Country:US
Mailing Address - Phone:707-579-1102
Mailing Address - Fax:707-579-1386
Practice Address - Street 1:990 SONOMA AVE STE 18
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4813
Practice Address - Country:US
Practice Address - Phone:707-579-1102
Practice Address - Fax:707-579-1386
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA391135363LF0000X
CA1377176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01437995OtherRAILROAD MEDICARE
CAP01437995OtherRAILROAD MEDICARE