Provider Demographics
NPI:1982919288
Name:MEDLEY, MONICA SUE (STNA)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:SUE
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 FLEMING FALLS RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44905
Mailing Address - Country:US
Mailing Address - Phone:419-566-2645
Mailing Address - Fax:
Practice Address - Street 1:516 FLEMING FALLS RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44905-1207
Practice Address - Country:US
Practice Address - Phone:419-566-2645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH378729390100172A00000X, 372600000X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No172A00000XOther Service ProvidersDriver
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH378729390100OtherOHIO DEPARTMENT OF HEALTH