MEDICARE: BONNIE SUE AMES-WERNET

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0200X	Pediatric Registered Nurse	RN264978	OH

General Provider Information

NPI Number	:	1316245269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE SUE AMES-WERNET

Provider Business Mailing Address
First Line	:	980 EVENING STAR AVE SE
Second Line	:
City	:	EAST CANTON
State	:	OH
Zip	:	44730-9445
Country	:	US
Telephone Number	:	330-704-7711
Fax Number	:

Provider Business Practice Location Address
First Line	:	980 EVENING STAR AVE S.E.
Second Line	:
City	:	EAST CANTON
State	:	OH
Zip	:	44730
Country	:	US
Telephone Number	:	330-704-7711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	03/02/2011

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