Healthcare Provider Details

I. General information

NPI: 1710928122
Provider Name (Legal Business Name): STELLA MARIE MONDAY RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4899 WILLOW RIDGE DR
HAMILTON OH
45011-0417
US

IV. Provider business mailing address

4899 WILLOW RIDGE DR
HAMILTON OH
45011-0417
US

V. Phone/Fax

Practice location:
  • Phone: 513-737-0840
  • Fax: 513-737-9354
Mailing address:
  • Phone: 513-737-0840
  • Fax: 513-737-9354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN 261417
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: