Provider Demographics
NPI:1730777517
Name:FOLEY, ANTOINETTE MONIQUE
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:MONIQUE
Last Name:FOLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 VALPARAISO ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108-3936
Mailing Address - Country:US
Mailing Address - Phone:269-830-6048
Mailing Address - Fax:
Practice Address - Street 1:2712 VALPARAISO ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-3936
Practice Address - Country:US
Practice Address - Phone:269-830-6048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1403808333OtherID