Provider Demographics
NPI:1275579633
Name:WILSON, MONIQUE (APRN-CNS)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:APRN-CNS
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:NEACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNS
Mailing Address - Street 1:5899 HARRISON AVENUE
Mailing Address - Street 2:MLC 6011
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45248
Mailing Address - Country:US
Mailing Address - Phone:513-803-8200
Mailing Address - Fax:513-803-8173
Practice Address - Street 1:5899 HARRISON AVENUE
Practice Address - Street 2:MLC 6011
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248
Practice Address - Country:US
Practice Address - Phone:513-803-8200
Practice Address - Fax:513-803-8173
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1092209163W00000X
KY3008200364SP0807X
OHAPRN.CNS.16189364SP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY184607OtherMEDICARE GROUP NUMBER
KY184607OtherMEDICARE GROUP NUMBER