MEDICARE: CARRIE MONIQUE WESLEY 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	164W00000X	Licensed Practical Nurse	PN. 126795 IV	OH
2	163W00000X	Registered Nurse	377030	OH

General Provider Information

NPI Number	:	1043405012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE MONIQUE WESLEY RN

Provider Business Mailing Address
First Line	:	5207 MARRUS LN
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	OH
Zip	:	44143-2972
Country	:	US
Telephone Number	:	216-338-7481
Fax Number	:

Provider Business Practice Location Address
First Line	:	5207 MARRUS LN
Second Line	:
City	:	RICHMOND HTS
State	:	OH
Zip	:	44143-2972
Country	:	US
Telephone Number	:	216-338-7481
Fax Number	:

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

Provider Enumeration Date	:	09/12/2007
Last Update Date	:	03/07/2025

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