Provider Demographics
NPI:1336592161
Name:HAKEEM, MONICA (LPN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:HAKEEM
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:ACKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:220 ARTHUR AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1100
Mailing Address - Country:US
Mailing Address - Phone:607-658-6792
Mailing Address - Fax:
Practice Address - Street 1:220 ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1100
Practice Address - Country:US
Practice Address - Phone:607-658-6792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-17
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296065164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse