Provider Demographics
NPI:1588119424
Name:CHURCH, WILLIAM E (RN)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:CHURCH
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 MARYLAND ST NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-3120
Mailing Address - Country:US
Mailing Address - Phone:330-442-2048
Mailing Address - Fax:
Practice Address - Street 1:936 MARYLAND ST NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-3120
Practice Address - Country:US
Practice Address - Phone:330-442-2048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-21
Last Update Date:2016-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN403777163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse