MEDICARE: MONE CROSS 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	163W00000X	Registered Nurse	RN489873	OH

General Provider Information

NPI Number	:	1265006571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONE CROSS RN

Provider Business Mailing Address
First Line	:	11004 PENFIELD AVE
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-2615
Country	:	US
Telephone Number	:	313-443-7635
Fax Number	:

Provider Business Practice Location Address
First Line	:	11004 PENFIELD AVE
Second Line	:
City	:	GARFIELD HEIGHTS
State	:	OH
Zip	:	44125-2615
Country	:	US
Telephone Number	:	313-443-7635
Fax Number	:

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

Provider Enumeration Date	:	05/20/2021
Last Update Date	:	05/20/2021

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