Provider Demographics
NPI:1275396814
Name:MONDAY, KEA R
Entity Type:Individual
Prefix:
First Name:KEA
Middle Name:R
Last Name:MONDAY
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 1:5269 AVERY ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-1703
Mailing Address - Country:US
Mailing Address - Phone:313-971-7320
Mailing Address - Fax:
Practice Address - Street 1:5245 AVERY ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-1703
Practice Address - Country:US
Practice Address - Phone:313-971-7320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty