Provider Demographics
NPI:1336504893
Name:CHONICH, WENONAH (RN)
Entity Type:Individual
Prefix:MS
First Name:WENONAH
Middle Name:
Last Name:CHONICH
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 1:17 S ELM ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:44047-1318
Mailing Address - Country:US
Mailing Address - Phone:440-645-8573
Mailing Address - Fax:
Practice Address - Street 1:17 S ELM ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:44047-1318
Practice Address - Country:US
Practice Address - Phone:440-645-8573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN221054163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse