Provider Demographics
NPI:1174667463
Name:DAVIS-KIRKMAN, MONICA LAUREEN
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:LAUREEN
Last Name:DAVIS-KIRKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MONICA
Other - Middle Name:LAUREEN
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE
Mailing Address - Street 1:24451 LAKE SHORE BLVD
Mailing Address - Street 2:303W
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-1272
Mailing Address - Country:US
Mailing Address - Phone:216-326-6870
Mailing Address - Fax:
Practice Address - Street 1:24451 LAKE SHORE BLVD
Practice Address - Street 2:303W
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-1272
Practice Address - Country:US
Practice Address - Phone:216-326-6870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH117283164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2653267Medicaid