Healthcare Provider Details

I. General information

NPI: 1609473552
Provider Name (Legal Business Name): MONICA ADESUWA TRIPLETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2020
Last Update Date: 10/05/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 PARKSIDE BLVD
TOLEDO OH
43607-1507
US

IV. Provider business mailing address

1430 PARKSIDE BLVD
TOLEDO OH
43607-1507
US

V. Phone/Fax

Practice location:
  • Phone: 419-932-4857
  • Fax:
Mailing address:
  • Phone: 419-932-4857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: