MEDICARE: AJA MONIQUE STYLES LPN

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	LPN085567	GA

General Provider Information

NPI Number	:	1134618309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AJA MONIQUE STYLES LPN

Provider Business Mailing Address
First Line	:	2702 STATION CLUB DR SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-7520
Country	:	US
Telephone Number	:	678-619-6925
Fax Number	:

Provider Business Practice Location Address
First Line	:	2702 STATION CLUB DR SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-7520
Country	:	US
Telephone Number	:	678-908-7697
Fax Number	:

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

Provider Enumeration Date	:	05/03/2018
Last Update Date	:	05/03/2018

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Directions to “ AJA MONIQUE STYLES LPN” Practice Location

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