MEDICARE: MRS. STELLA MARIE MONDAY RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	RN 261417	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RN261417	OTHER	OH	RN LICENCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710928122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STELLA MARIE MONDAY RN

Provider Business Mailing Address
First Line	:	4899 WILLOW RIDGE DR
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45011-0417
Country	:	US
Telephone Number	:	513-737-0840
Fax Number	:	513-737-9354

Provider Business Practice Location Address
First Line	:	4899 WILLOW RIDGE DR
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45011-0417
Country	:	US
Telephone Number	:	513-737-0840
Fax Number	:	513-737-9354

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	07/09/2007

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