Provider Demographics
NPI:1396904157
Name:VONGUNTEN, NADINE L
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:L
Last Name:VONGUNTEN
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 1:1264 BUCKINGHAM GATE BLVD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-5336
Mailing Address - Country:US
Mailing Address - Phone:330-701-0431
Mailing Address - Fax:
Practice Address - Street 1:1264 BUCKINGHAM GATE BLVD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-5336
Practice Address - Country:US
Practice Address - Phone:330-701-0431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2791813Medicaid