Provider Demographics
NPI:1861059750
Name:MONROSE, JOLIVIA
Entity type:Individual
Prefix:
First Name:JOLIVIA
Middle Name:
Last Name:MONROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOLIVIA
Other - Middle Name:
Other - Last Name:MONROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2525 CHURCH AVE APT E2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-4044
Mailing Address - Country:US
Mailing Address - Phone:347-866-5210
Mailing Address - Fax:
Practice Address - Street 1:611 E 103RD ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-2501
Practice Address - Country:US
Practice Address - Phone:718-240-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-25
Last Update Date:2019-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334867164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse