Provider Demographics
NPI:1225017114
Name:ONDUS, KATHLEEN A (GCNS, BC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:ONDUS
Suffix:
Gender:F
Credentials:GCNS, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 TOWER BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44052-5200
Mailing Address - Country:US
Mailing Address - Phone:440-989-4874
Mailing Address - Fax:440-989-4878
Practice Address - Street 1:1130 TOWER BLVD STE B
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-5200
Practice Address - Country:US
Practice Address - Phone:440-989-4874
Practice Address - Fax:440-989-4878
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA01616-NS364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2570874Medicaid
OH02241Medicare PIN
OH2570874Medicaid