1306004890 NPI number — MRS. MONICA CHESHA STINSON L.V.N

Table of content: MRS. MONICA CHESHA STINSON L.V.N (NPI 1306004890)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306004890 NPI number — MRS. MONICA CHESHA STINSON L.V.N

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STINSON
Provider First Name:
MONICA
Provider Middle Name:
CHESHA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
L.V.N
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STINSON
Provider Other First Name:
MONICA
Provider Other Middle Name:
CHESHA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.V.N
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306004890
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4851 KOKOMO DR
Provider Second Line Business Mailing Address:
APT 7311
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95835-1840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-346-3103
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4851 KOKOMO DR
Provider Second Line Business Practice Location Address:
APT 7311
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95835-1840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-346-3103
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2008

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: 164X00000X , with the licence number:  VN195142 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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