Provider Demographics
NPI:1043405012
Name:WESLEY, CARRIE MONIQUE (RN)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:MONIQUE
Last Name:WESLEY
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 1:3107 E 67TH ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44127-1427
Mailing Address - Country:US
Mailing Address - Phone:216-338-7481
Mailing Address - Fax:
Practice Address - Street 1:3107 E 67TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44127-1427
Practice Address - Country:US
Practice Address - Phone:216-338-7481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN. 126795 IV164W00000X
OH377030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse