Provider Demographics
NPI:1992453369
Name:HARLOCK, MONICA RAE
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:RAE
Last Name:HARLOCK
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 1:1213 DONALD DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45331-2603
Mailing Address - Country:US
Mailing Address - Phone:740-357-7141
Mailing Address - Fax:
Practice Address - Street 1:68 E STAR RD
Practice Address - Street 2:
Practice Address - City:ROSSBURG
Practice Address - State:OH
Practice Address - Zip Code:45362-9706
Practice Address - Country:US
Practice Address - Phone:937-423-1894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant