Provider Demographics
NPI:1760736706
Name:GRIDER HALL, MONIQUE (RN)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:GRIDER HALL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:RENEE
Other - Last Name:GRIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:13203 MAPLEROW AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44105-6925
Mailing Address - Country:US
Mailing Address - Phone:443-801-2854
Mailing Address - Fax:
Practice Address - Street 1:13203 MAPLEROW AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44105-6925
Practice Address - Country:US
Practice Address - Phone:443-801-2854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH379529163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health