Provider Demographics
NPI:1982073789
Name:PLATT, MONIQUE SHEREE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:SHEREE
Last Name:PLATT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:MS
Other - First Name:MONIQUE
Other - Middle Name:SHEREE
Other - Last Name:BRANCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2606 BIRCH STREET
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92410-1918
Mailing Address - Country:US
Mailing Address - Phone:909-496-8109
Mailing Address - Fax:
Practice Address - Street 1:2606 BIRCH STREET
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92410-1918
Practice Address - Country:US
Practice Address - Phone:909-496-8109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN221488164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse