Provider Demographics
NPI:1639381528
Name:MADISON, MONICA LISA (LVN)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:LISA
Last Name:MADISON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20465 RED POPPY LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-3118
Mailing Address - Country:US
Mailing Address - Phone:909-816-3682
Mailing Address - Fax:
Practice Address - Street 1:20465 RED POPPY LN
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-3118
Practice Address - Country:US
Practice Address - Phone:909-816-3682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALV210494164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse