Provider Demographics
NPI:1508950387
Name:BEARS, MONICA REVAE (LPN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:REVAE
Last Name:BEARS
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:RR 2 BOX 115
Mailing Address - Street 2:
Mailing Address - City:SWEET SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65351-9348
Mailing Address - Country:US
Mailing Address - Phone:660-335-4138
Mailing Address - Fax:
Practice Address - Street 1:5308 LONGVIEW RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-2731
Practice Address - Country:US
Practice Address - Phone:816-763-9165
Practice Address - Fax:816-763-9208
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004029600164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse