Provider Demographics
NPI:1730740630
Name:GHANEM, KHATREN (RN)
Entity type:Individual
Prefix:MRS
First Name:KHATREN
Middle Name:
Last Name:GHANEM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25813 MELIBEE DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5458
Mailing Address - Country:US
Mailing Address - Phone:440-666-0007
Mailing Address - Fax:
Practice Address - Street 1:25812 MELIBEE DR
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5459
Practice Address - Country:US
Practice Address - Phone:440-666-0007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-22
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN4413395163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4413395OtherRN