Provider Demographics
NPI:1407038185
Name:AMMON, MONIQUE KIFFANY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:KIFFANY
Last Name:AMMON
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 1:46 OAKBRIAR CT
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2635
Mailing Address - Country:US
Mailing Address - Phone:585-678-4279
Mailing Address - Fax:
Practice Address - Street 1:46 OAKBRIAR CT
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2635
Practice Address - Country:US
Practice Address - Phone:585-678-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY278655164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse