Provider Demographics
NPI:1609467422
Name:PEARCE, MONIQUE LASHAWN
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:LASHAWN
Last Name:PEARCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 GLENWAY DR APT 6
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-4044
Mailing Address - Country:US
Mailing Address - Phone:310-350-1820
Mailing Address - Fax:
Practice Address - Street 1:700 GLENWAY DR APT 6
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-4044
Practice Address - Country:US
Practice Address - Phone:310-350-1820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA703731164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse