Provider Demographics
NPI:1861017030
Name:COLE, ESSENCE MONIQUE
Entity Type:Individual
Prefix:
First Name:ESSENCE
Middle Name:MONIQUE
Last Name:COLE
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 1:108 S GLENELLEN AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-2707
Mailing Address - Country:US
Mailing Address - Phone:330-301-8413
Mailing Address - Fax:
Practice Address - Street 1:108 S GLENELLEN AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-2707
Practice Address - Country:US
Practice Address - Phone:330-301-8413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health