Provider Demographics
NPI:1114187143
Name:KISLEY, MONICA JEAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:JEAN
Last Name:KISLEY
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 1:1591 GREENFIELD LN
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-6114
Mailing Address - Country:US
Mailing Address - Phone:440-350-0237
Mailing Address - Fax:
Practice Address - Street 1:1591 GREENFIELD LN
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-6114
Practice Address - Country:US
Practice Address - Phone:440-350-0237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN2774163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse