Healthcare Provider Details

I. General information

NPI: 1548096498
Provider Name (Legal Business Name): MAKENZIE ANN MONSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 BEECHCREST ST NW
WARREN OH
44485-1930
US

IV. Provider business mailing address

1359 BEECHCREST ST NW
WARREN OH
44485-1930
US

V. Phone/Fax

Practice location:
  • Phone: 330-245-8273
  • Fax:
Mailing address:
  • Phone: 330-245-8273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: