Provider Demographics
NPI:1679226807
Name:ADEMOLA, MONICA RICHARDSON (FNP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:RICHARDSON
Last Name:ADEMOLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 RICE MILL RD
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-6023
Mailing Address - Country:US
Mailing Address - Phone:912-352-6388
Mailing Address - Fax:
Practice Address - Street 1:150 SCRANTON CONNECTOR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-0540
Practice Address - Country:US
Practice Address - Phone:912-262-2300
Practice Address - Fax:912-262-3333
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN249568363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner