Provider Demographics
NPI:1487003901
Name:PHELPS, MONICA (LPN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:PHELPS
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 1:13049 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BEACH PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60099-9791
Mailing Address - Country:US
Mailing Address - Phone:262-515-3385
Mailing Address - Fax:224-789-7151
Practice Address - Street 1:13049 W 29TH ST
Practice Address - Street 2:
Practice Address - City:BEACH PARK
Practice Address - State:IL
Practice Address - Zip Code:60099-9791
Practice Address - Country:US
Practice Address - Phone:262-515-3385
Practice Address - Fax:224-789-7151
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI318497164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse