Provider Demographics
NPI:1992272728
Name:KOMLA EKLU, MONIQUE AKOSSIWA (LVN)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:AKOSSIWA
Last Name:KOMLA EKLU
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4619 EVERSTONE CRK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4717
Mailing Address - Country:US
Mailing Address - Phone:210-544-4614
Mailing Address - Fax:
Practice Address - Street 1:4619 EVERSTONE CRK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4717
Practice Address - Country:US
Practice Address - Phone:210-544-4614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336678164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse