Provider Demographics
NPI:1588754097
Name:RENDA, JOLENE (APN/CNP)
Entity type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:RENDA
Suffix:
Gender:F
Credentials:APN/CNP
Other - Prefix:
Other - First Name:JOLENE
Other - Middle Name:
Other - Last Name:RIETFORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN/CNP
Mailing Address - Street 1:7047 DIVISION RD
Mailing Address - Street 2:
Mailing Address - City:TOMAH
Mailing Address - State:WI
Mailing Address - Zip Code:54660-4365
Mailing Address - Country:US
Mailing Address - Phone:608-315-0271
Mailing Address - Fax:608-372-1259
Practice Address - Street 1:500 E VETERANS ST
Practice Address - Street 2:
Practice Address - City:TOMAH
Practice Address - State:WI
Practice Address - Zip Code:54660-3105
Practice Address - Country:US
Practice Address - Phone:608-372-1264
Practice Address - Fax:608-372-1259
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care