Provider Demographics
NPI:1508559436
Name:MACLIN, MONIQUE (CARE PROVIDER B&B)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:MACLIN
Suffix:
Gender:F
Credentials:CARE PROVIDER B&B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8869 W APPLETON AVE UNIT 15
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4200
Mailing Address - Country:US
Mailing Address - Phone:414-595-3411
Mailing Address - Fax:
Practice Address - Street 1:8869 W APPLETON AVE UNIT 15
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-4200
Practice Address - Country:US
Practice Address - Phone:414-595-3411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider