Provider Demographics
NPI:1841665759
Name:WOOTTON, RHONDA (BSN)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:WOOTTON
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 HARMAN AVE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-3845
Mailing Address - Country:US
Mailing Address - Phone:937-232-5399
Mailing Address - Fax:
Practice Address - Street 1:3750 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-2506
Practice Address - Country:US
Practice Address - Phone:937-499-1653
Practice Address - Fax:937-499-1717
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH283049163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse