Provider Demographics
NPI:1417577115
Name:TENORIO, MONICA ADRIANA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ADRIANA
Last Name:TENORIO
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 1:260 NORTHLAND BLVD STE 329
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-4921
Mailing Address - Country:US
Mailing Address - Phone:937-536-3433
Mailing Address - Fax:
Practice Address - Street 1:260 NORTHLAND BLVD STE 329
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-4921
Practice Address - Country:US
Practice Address - Phone:937-536-3433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHNONEMedicaid