Provider Demographics
NPI:1477164929
Name:LEE, MONIQUE L
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:L
Last Name:LEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ML
Other - Middle Name:NURSE
Other - Last Name:CONSULTANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN, NC
Mailing Address - Street 1:8528 S EXCHANGE AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-2541
Mailing Address - Country:US
Mailing Address - Phone:872-777-1455
Mailing Address - Fax:312-428-9349
Practice Address - Street 1:8528 S EXCHANGE AVE # 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-2541
Practice Address - Country:US
Practice Address - Phone:872-777-1455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL043088275164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse