Provider Demographics
NPI:1952721961
Name:BARKSDALE, MONICA LYNN (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:LYNN
Last Name:BARKSDALE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:L
Other - Last Name:BACHILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:141 MARVIN RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-2244
Mailing Address - Country:US
Mailing Address - Phone:315-516-6689
Mailing Address - Fax:
Practice Address - Street 1:141 MARVIN RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207-2244
Practice Address - Country:US
Practice Address - Phone:315-516-6689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-17
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY318309164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse