Provider Demographics
NPI:1003944729
Name:MOCK, MONIQUE LADOSCA (CNA, MED TECH)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:LADOSCA
Last Name:MOCK
Suffix:
Gender:F
Credentials:CNA, MED TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 SWAIM WOODS LN
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27107-5461
Mailing Address - Country:US
Mailing Address - Phone:336-793-6007
Mailing Address - Fax:
Practice Address - Street 1:1065 SWAIM WOODS LN
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27107-5461
Practice Address - Country:US
Practice Address - Phone:336-793-6007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant