Provider Demographics
NPI:1184291304
Name:SCOTT, MONIQUEA LONETTA (LVN)
Entity type:Individual
Prefix:
First Name:MONIQUEA
Middle Name:LONETTA
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 PELUCCA LN
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-1452
Mailing Address - Country:US
Mailing Address - Phone:916-549-0727
Mailing Address - Fax:
Practice Address - Street 1:1768 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2156
Practice Address - Country:US
Practice Address - Phone:209-353-4838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA290190164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse