Provider Demographics
NPI:1275230724
Name:MONGEAU, AIMEE JEAN
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:JEAN
Last Name:MONGEAU
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 1:459 S JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:OH
Mailing Address - Zip Code:44883-3450
Mailing Address - Country:US
Mailing Address - Phone:419-934-0543
Mailing Address - Fax:
Practice Address - Street 1:459 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:TIFFIN
Practice Address - State:OH
Practice Address - Zip Code:44883-3450
Practice Address - Country:US
Practice Address - Phone:419-934-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHHFR4593343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)