Provider Demographics
NPI:1417454588
Name:MONGEAU, DREAMA
Entity Type:Individual
Prefix:MRS
First Name:DREAMA
Middle Name:
Last Name:MONGEAU
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 1:724 LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-2639
Mailing Address - Country:US
Mailing Address - Phone:740-371-4050
Mailing Address - Fax:
Practice Address - Street 1:724 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2639
Practice Address - Country:US
Practice Address - Phone:740-371-4050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health