Provider Demographics
NPI:1467211169
Name:THOMAS, MONIQUE CHANTELLE
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:CHANTELLE
Last Name:THOMAS
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 1:3503 PENFIELD CT W
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-3732
Mailing Address - Country:US
Mailing Address - Phone:161-495-7614
Mailing Address - Fax:
Practice Address - Street 1:3503 PENFIELD CT W
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-3732
Practice Address - Country:US
Practice Address - Phone:614-957-6146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health Aide