Provider Demographics
NPI:1174750921
Name:EKSTRAND, RAMONA MARIE (LPN)
Entity type:Individual
Prefix:MRS
First Name:RAMONA
Middle Name:MARIE
Last Name:EKSTRAND
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 MEMORY LANE
Mailing Address - Street 2:PO BOX 29
Mailing Address - City:FENCE
Mailing Address - State:WI
Mailing Address - Zip Code:54120-0029
Mailing Address - Country:US
Mailing Address - Phone:715-336-2198
Mailing Address - Fax:
Practice Address - Street 1:626 MEMORY LN
Practice Address - Street 2:
Practice Address - City:FENCE
Practice Address - State:WI
Practice Address - Zip Code:54120-0029
Practice Address - Country:US
Practice Address - Phone:715-336-2198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4703083035164W00000X
WI31264031164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35069000Medicaid