Provider Demographics
NPI:1326222449
Name:MOLINA, MONICA DACEY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:DACEY
Last Name:MOLINA
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 1:53 COMFORT ROAD
Mailing Address - Street 2:APT #4
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-8627
Mailing Address - Country:US
Mailing Address - Phone:607-269-0149
Mailing Address - Fax:
Practice Address - Street 1:53 COMFORT RD
Practice Address - Street 2:APT #4
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-8627
Practice Address - Country:US
Practice Address - Phone:607-269-0149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081164-1374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel