Healthcare Provider Details

I. General information

NPI: 1760813711
Provider Name (Legal Business Name): MRS. DANELLA MONSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. DANELLA WALKER

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 12/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 BELMONT AVE NE
WARREN OH
44483-4942
US

IV. Provider business mailing address

591 BELMONT AVE NE
WARREN OH
44483-4942
US

V. Phone/Fax

Practice location:
  • Phone: 330-469-5000
  • Fax:
Mailing address:
  • Phone: 330-469-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number400692491107
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: