Provider Demographics
NPI:1326349721
Name:LEE, MONICA ANITA (STNA)
Entity Type:Individual
Prefix:MISS
First Name:MONICA
Middle Name:ANITA
Last Name:LEE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:PAINESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44077-3567
Mailing Address - Country:US
Mailing Address - Phone:440-479-9835
Mailing Address - Fax:
Practice Address - Street 1:128 PEARL ST
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-3567
Practice Address - Country:US
Practice Address - Phone:440-479-9835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401077040510313M00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility