Provider Demographics
NPI:1093482390
Name:CHURCH, RHONDA (RN)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:CHURCH
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 1:24124 ROAD 207
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45873-9536
Mailing Address - Country:US
Mailing Address - Phone:937-570-1758
Mailing Address - Fax:
Practice Address - Street 1:600 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322-1469
Practice Address - Country:US
Practice Address - Phone:937-540-0460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH193364163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse