Provider Demographics
NPI:1083407217
Name:KING, WENONAH
Entity type:Individual
Prefix:
First Name:WENONAH
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:824 CLARENDON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43223-2015
Mailing Address - Country:US
Mailing Address - Phone:380-278-6034
Mailing Address - Fax:
Practice Address - Street 1:824 CLARENDON AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43223-2015
Practice Address - Country:US
Practice Address - Phone:380-278-6034
Practice Address - Fax:380-278-6034
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health