Provider Demographics
NPI:1083920235
Name:TREASURE, MONIQUE ELIZABETH
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ELIZABETH
Last Name:TREASURE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:ELIZABETH
Other - Last Name:HYLTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:7212 BROOKE BLVD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-5273
Mailing Address - Country:US
Mailing Address - Phone:614-282-9429
Mailing Address - Fax:
Practice Address - Street 1:7212 BROOKE BLVD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-5273
Practice Address - Country:US
Practice Address - Phone:614-282-9429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH134861164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse