Provider Demographics
NPI:1013296383
Name:PRIMM, MONIQUE LYNETTE (LPN)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:LYNETTE
Last Name:PRIMM
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 1:390 E 210TH ST
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2173
Mailing Address - Country:US
Mailing Address - Phone:216-240-5957
Mailing Address - Fax:
Practice Address - Street 1:390 E 210TH ST
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44123-2173
Practice Address - Country:US
Practice Address - Phone:216-240-5957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN118601164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse