Provider Demographics
NPI:1225300254
Name:PLANK, MONICA L (LPN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:PLANK
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11849 E CORNING RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-3695
Mailing Address - Country:US
Mailing Address - Phone:607-962-0102
Mailing Address - Fax:
Practice Address - Street 1:11849 E CORNING RD
Practice Address - Street 2:SUITE 108
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-3695
Practice Address - Country:US
Practice Address - Phone:607-962-0102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272386164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse