Provider Demographics
NPI:1912058777
Name:EUBANK, RHONDA SUE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:RHONDA
Middle Name:SUE
Last Name:EUBANK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 PARKWAY ST NW STE A
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-3982
Mailing Address - Country:US
Mailing Address - Phone:330-452-9460
Mailing Address - Fax:
Practice Address - Street 1:3120 PARKWAY ST NW STE A
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-3982
Practice Address - Country:US
Practice Address - Phone:330-452-9460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-02162363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2165348Medicaid