Provider Demographics
NPI:1588083877
Name:DECLUETT, MONIQUE (LPN)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:DECLUETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:
Other - Last Name:MARTIN-DECLUETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:5985 WHITE PINE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3005
Mailing Address - Country:US
Mailing Address - Phone:440-317-3823
Mailing Address - Fax:
Practice Address - Street 1:5985 WHITE PINE DR
Practice Address - Street 2:
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-3005
Practice Address - Country:US
Practice Address - Phone:440-317-3823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH139684164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse