Provider Demographics
NPI:1669445409
Name:SCHMUCKER, MONIQUE TERHAAR (LPN)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:TERHAAR
Last Name:SCHMUCKER
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 1:19969 PARROTT BLVD
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9786
Mailing Address - Country:US
Mailing Address - Phone:614-738-5929
Mailing Address - Fax:
Practice Address - Street 1:19969 PARROTT BLVD
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9786
Practice Address - Country:US
Practice Address - Phone:614-738-5929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-079205164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2123893Medicaid