Provider Demographics
NPI:1386108397
Name:WILLIS, MONICA LACOLE
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:LACOLE
Last Name:WILLIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5418 NEWFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-5319
Mailing Address - Country:US
Mailing Address - Phone:513-391-0254
Mailing Address - Fax:
Practice Address - Street 1:5418 NEWFIELD AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-5319
Practice Address - Country:US
Practice Address - Phone:513-391-0254
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-23
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide