Provider Demographics
NPI:1689164972
Name:HIMMEL JUSTUS, RHONDA LEE
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:LEE
Last Name:HIMMEL JUSTUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 RANCHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1505
Mailing Address - Country:US
Mailing Address - Phone:216-536-1534
Mailing Address - Fax:
Practice Address - Street 1:1145 RANCHLAND DR
Practice Address - Street 2:
Practice Address - City:MAYFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44124-1505
Practice Address - Country:US
Practice Address - Phone:216-536-1534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH405745163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical