Provider Demographics
NPI:1972836062
Name:ZOLLICOFFER, KENYA MONIQUE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:KENYA
Middle Name:MONIQUE
Last Name:ZOLLICOFFER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2114 MARKET AVE N APT 4
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44714-1971
Mailing Address - Country:US
Mailing Address - Phone:330-575-0108
Mailing Address - Fax:
Practice Address - Street 1:2114 MARKET AVE N APT 4
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44714-1971
Practice Address - Country:US
Practice Address - Phone:330-575-0108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN.129518-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse