Provider Demographics
NPI:1942256003
Name:CONN, RHONDA S (CNP)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:S
Last Name:CONN
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20455 LORAIN RD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-3494
Mailing Address - Country:US
Mailing Address - Phone:440-333-8600
Mailing Address - Fax:440-333-5015
Practice Address - Street 1:20455 LORAIN RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-3494
Practice Address - Country:US
Practice Address - Phone:440-333-8600
Practice Address - Fax:440-333-5015
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-220262363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2420482Medicaid
OH05237Medicare PIN
OHP01148Medicare UPIN