1376979179 NPI number — MRS. MONIQUE DASHAY STEELE LPN

Table of content: MRS. MONIQUE DASHAY STEELE LPN (NPI 1376979179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376979179 NPI number — MRS. MONIQUE DASHAY STEELE LPN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STEELE
Provider First Name:
MONIQUE
Provider Middle Name:
DASHAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ELLIOTT
Provider Other First Name:
MONIQUE
Provider Other Middle Name:
DASHAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376979179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33400 VINE ST
Provider Second Line Business Mailing Address:
102D
Provider Business Mailing Address City Name:
WILLOWICK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44095-3471
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-316-8381
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33400 VINE ST
Provider Second Line Business Practice Location Address:
102D
Provider Business Practice Location Address City Name:
WILLOWICK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44095-3471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-316-8381
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 164W00000X , with the licence number:  PN.144739-M-IV , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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