Provider Demographics
NPI:1346529583
Name:KRENGULEC, DAWNA JEAN (RN)
Entity Type:Individual
Prefix:
First Name:DAWNA
Middle Name:JEAN
Last Name:KRENGULEC
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 1:4316 STATE RD
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-6019
Mailing Address - Country:US
Mailing Address - Phone:440-344-4466
Mailing Address - Fax:
Practice Address - Street 1:4316 STATE RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6019
Practice Address - Country:US
Practice Address - Phone:440-344-4466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 279557163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice