Provider Demographics
NPI:1457977027
Name:DAVIS, MONIQUE L
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:L
Last Name:DAVIS
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 1:4362 FOXCHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-2110
Mailing Address - Country:US
Mailing Address - Phone:419-215-7772
Mailing Address - Fax:
Practice Address - Street 1:202 TORRINGTON DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-5431
Practice Address - Country:US
Practice Address - Phone:419-215-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide