Provider Demographics
NPI:1346459187
Name:BOHANON, ANTOINETTE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:
Last Name:BOHANON
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 1:693 QUILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1964
Mailing Address - Country:US
Mailing Address - Phone:216-691-1561
Mailing Address - Fax:
Practice Address - Street 1:693 QUILLIAMS RD
Practice Address - Street 2:
Practice Address - City:SOUTH EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44121-1964
Practice Address - Country:US
Practice Address - Phone:216-691-1561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH310952163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse