Provider Demographics
NPI:1073857827
Name:PONDER, JONIQUE (RN)
Entity Type:Individual
Prefix:
First Name:JONIQUE
Middle Name:
Last Name:PONDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BRIGHT OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-4732
Mailing Address - Country:US
Mailing Address - Phone:585-503-7622
Mailing Address - Fax:
Practice Address - Street 1:87 ELDER ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-5607
Practice Address - Country:US
Practice Address - Phone:585-503-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-17
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311330164W00000X
NY755664163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse