Provider Demographics
NPI:1609009323
Name:MCDIVITT, RHONDA S (LPN)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:S
Last Name:MCDIVITT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4183 S RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:OH
Mailing Address - Zip Code:44081-9648
Mailing Address - Country:US
Mailing Address - Phone:440-725-1258
Mailing Address - Fax:
Practice Address - Street 1:4183 S RIDGE RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:OH
Practice Address - Zip Code:44081-9648
Practice Address - Country:US
Practice Address - Phone:440-725-1258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH099036164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse