Healthcare Provider Details

I. General information

NPI: 1316245269
Provider Name (Legal Business Name): BONNIE SUE AMES-WERNET
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2011
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 EVENING STAR AVE S.E.
EAST CANTON OH
44730
US

IV. Provider business mailing address

980 EVENING STAR AVE SE
EAST CANTON OH
44730-9445
US

V. Phone/Fax

Practice location:
  • Phone: 330-704-7711
  • Fax:
Mailing address:
  • Phone: 330-704-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN264978
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: