Provider Demographics
NPI:1770320574
Name:KENDALL, MONICA DIONNE (CNA)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:DIONNE
Last Name:KENDALL
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WINDSOR SHORES DR APT 25C
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-1716
Mailing Address - Country:US
Mailing Address - Phone:803-466-8776
Mailing Address - Fax:
Practice Address - Street 1:1000 WINDSOR SHORES DR APT 25C
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-1716
Practice Address - Country:US
Practice Address - Phone:803-466-8776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9985155376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide