Provider Demographics
NPI:1760814255
Name:ATWOOD, RONDA JEAN (STNA/CTA)
Entity Type:Individual
Prefix:
First Name:RONDA
Middle Name:JEAN
Last Name:ATWOOD
Suffix:
Gender:F
Credentials:STNA/CTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-5945
Mailing Address - Country:US
Mailing Address - Phone:440-536-5151
Mailing Address - Fax:
Practice Address - Street 1:3726 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-5945
Practice Address - Country:US
Practice Address - Phone:440-536-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH378873310600376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH378873310600OtherSTATE TESTED NURSING ASSISTANT