Provider Demographics
NPI:1407396609
Name:DURHAM, RHONDA MICHELLE (A-GNP-C)
Entity type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:MICHELLE
Last Name:DURHAM
Suffix:
Gender:F
Credentials:A-GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 MARS AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3825
Mailing Address - Country:US
Mailing Address - Phone:216-712-6556
Mailing Address - Fax:216-712-6596
Practice Address - Street 1:60 OKATIE VILLAGE DR
Practice Address - Street 2:
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-6554
Practice Address - Country:US
Practice Address - Phone:843-548-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN154981163W00000X, 363LP2300X
SCAPN.21872RX363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse