Provider Demographics
NPI:1811397318
Name:FRAWLEY, MONICA BERADINE (LPN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:BERADINE
Last Name:FRAWLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:BERADINE
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:415A HOWARD RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:NY
Mailing Address - Zip Code:13069-4212
Mailing Address - Country:US
Mailing Address - Phone:315-561-3086
Mailing Address - Fax:
Practice Address - Street 1:104 W UTICA ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3031
Practice Address - Country:US
Practice Address - Phone:315-342-1390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305567164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse