Provider Demographics
NPI:1508178294
Name:ANDERSON, MONICA GAIL (LPN)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:GAIL
Last Name:ANDERSON
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 1:23952 BANBURY CIR
Mailing Address - Street 2:APT. F6
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5320
Mailing Address - Country:US
Mailing Address - Phone:216-376-7496
Mailing Address - Fax:
Practice Address - Street 1:23952 BANBURY CIR
Practice Address - Street 2:APT. F6
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5320
Practice Address - Country:US
Practice Address - Phone:216-376-7496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN140311164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse