Provider Demographics
NPI:1215690441
Name:CLAMOHOY, MARNICHELLE KY BONOCAN (RN)
Entity type:Individual
Prefix:MS
First Name:MARNICHELLE KY
Middle Name:BONOCAN
Last Name:CLAMOHOY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:MARNICHELLE KY
Other - Middle Name:BONOCAN
Other - Last Name:CLAMOHOY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:604 E OAKLAND AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-3469
Mailing Address - Country:US
Mailing Address - Phone:423-676-5764
Mailing Address - Fax:
Practice Address - Street 1:102 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-3525
Practice Address - Country:US
Practice Address - Phone:423-588-9978
Practice Address - Fax:423-722-3401
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN255300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse