Provider Demographics
NPI:1154808269
Name:NOOKS, RONSHAE LATRISE
Entity type:Individual
Prefix:MS
First Name:RONSHAE
Middle Name:LATRISE
Last Name:NOOKS
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 1:101 OUTER BELLE RD APT D
Mailing Address - Street 2:
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-1523
Mailing Address - Country:US
Mailing Address - Phone:937-248-3142
Mailing Address - Fax:
Practice Address - Street 1:101 OUTER BELLE RD APT D
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-1523
Practice Address - Country:US
Practice Address - Phone:937-248-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-21
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRT295866251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health