Provider Demographics
NPI:1578826145
Name:DUCHAINE, GWENDOLYN M (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:GWENDOLYN
Middle Name:M
Last Name:DUCHAINE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1969 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-4016
Mailing Address - Country:US
Mailing Address - Phone:330-990-8804
Mailing Address - Fax:
Practice Address - Street 1:1969 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-4016
Practice Address - Country:US
Practice Address - Phone:330-990-8804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN433909163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse