Provider Demographics
NPI:1659811925
Name:TITUS, MONIQUE DEANN (LPN)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:DEANN
Last Name:TITUS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:DEANN
Other - Last Name:PERNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5410 TRANSPORTATION BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125-5300
Mailing Address - Country:US
Mailing Address - Phone:440-953-9999
Mailing Address - Fax:
Practice Address - Street 1:5410 TRANSPORTATION BLVD STE 4
Practice Address - Street 2:
Practice Address - City:GARFIELD HTS
Practice Address - State:OH
Practice Address - Zip Code:44125-5300
Practice Address - Country:US
Practice Address - Phone:440-953-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.160532.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse