Provider Demographics
NPI:1801040977
Name:DAUGHERTY, MONICA (FNP-C)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24560 LAING RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-4037
Mailing Address - Country:US
Mailing Address - Phone:216-288-2563
Mailing Address - Fax:
Practice Address - Street 1:19300 MAYFAIR LN
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2725
Practice Address - Country:US
Practice Address - Phone:216-283-0041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-15
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 337886163WW0000X, 163WM0705X
OH024461363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0340754OtherFNP PROVIDER #