Provider Demographics
NPI:1215542790
Name:DAVIS, MONIQUE DIENE
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:DIENE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11837 S PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-6011
Mailing Address - Country:US
Mailing Address - Phone:312-493-9503
Mailing Address - Fax:
Practice Address - Street 1:11837 S PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-6011
Practice Address - Country:US
Practice Address - Phone:312-493-9503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide