1801040977 NPI number — MONICA DAUGHERTY FNP-C

Table of content: MONICA DAUGHERTY FNP-C (NPI 1801040977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801040977 NPI number — MONICA DAUGHERTY FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAUGHERTY
Provider First Name:
MONICA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801040977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24560 LAING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD HTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44146-4037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-288-2563
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19300 MAYFAIR LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44128-2725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-283-0041
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2008

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: 163WW0000X , with the licence number:  RN 337886 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 024461 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WM0705X , with the licence number: RN 337886 , 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)

  • Identifier: 0340754 . This is a "FNP PROVIDER #" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com