Provider Demographics
NPI:1942919162
Name:DOTSON, MONIQUE (MSN,RN)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:DOTSON
Suffix:
Gender:F
Credentials:MSN,RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42383 GARFIELD RD STE 381224
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-9997
Mailing Address - Country:US
Mailing Address - Phone:313-445-3495
Mailing Address - Fax:
Practice Address - Street 1:39090 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-4093
Practice Address - Country:US
Practice Address - Phone:313-445-3495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-16
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704289715163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse