Provider Demographics
NPI:1356129878
Name:FRANKLIN, MONEIK (LPN)
Entity type:Individual
Prefix:
First Name:MONEIK
Middle Name:
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:MONEIK
Other - Middle Name:
Other - Last Name:FRANKLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4350 211TH ST STE 210A
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3082
Mailing Address - Country:US
Mailing Address - Phone:773-676-0369
Mailing Address - Fax:
Practice Address - Street 1:600 HOLIDAY PLAZA DR STE 501
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-2359
Practice Address - Country:US
Practice Address - Phone:773-676-0365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
IL043109473164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No291U00000XLaboratoriesClinical Medical Laboratory