Provider Demographics
NPI:1851707368
Name:GAINES, MONIQUE
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5679 FOLCHI DR
Mailing Address - Street 2:#1
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-3253
Mailing Address - Country:US
Mailing Address - Phone:513-972-9403
Mailing Address - Fax:
Practice Address - Street 1:5679 FOLCHI DR
Practice Address - Street 2:#1
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-3253
Practice Address - Country:US
Practice Address - Phone:513-972-9403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3747P1801X, 172A00000X, 376J00000X
OH401476141212376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver
No376K00000XNursing Service Related ProvidersNurse's Aide