Provider Demographics
NPI:1326845033
Name:WAGNER, MONIQUE J
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:J
Last Name:WAGNER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9834 DENISON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-4631
Mailing Address - Country:US
Mailing Address - Phone:216-424-0345
Mailing Address - Fax:
Practice Address - Street 1:9834 DENISON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-4631
Practice Address - Country:US
Practice Address - Phone:216-424-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care