Healthcare Provider Details

I. General information

NPI: 1154650836
Provider Name (Legal Business Name): RHONDA KAY ELLIOTT CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 HOSPITAL RD
CHILLICOTHEE OH
45601-9031
US

IV. Provider business mailing address

1595 HANLEY RD
JACKSON OH
45640-9098
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-8873
  • Fax:
Mailing address:
  • Phone: 740-286-8721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number232187
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: