Provider Demographics
NPI:1881250496
Name:VONKANEL, GWENDOLYN PAIGE (RN)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:PAIGE
Last Name:VONKANEL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:
Other - Last Name:VON KANEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 2192
Mailing Address - Street 2:
Mailing Address - City:FORREST CITY
Mailing Address - State:AR
Mailing Address - Zip Code:72336-2192
Mailing Address - Country:US
Mailing Address - Phone:870-208-8362
Mailing Address - Fax:870-208-8384
Practice Address - Street 1:515 MCDONOUGH
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:AR
Practice Address - Zip Code:72342-2912
Practice Address - Country:US
Practice Address - Phone:870-338-8106
Practice Address - Fax:870-338-8106
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR054643163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse