Provider Demographics
NPI:1609352913
Name:APODACA, MONA-ELAINE (LVN)
Entity type:Individual
Prefix:
First Name:MONA-ELAINE
Middle Name:
Last Name:APODACA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:MONA-ELAINE
Other - Middle Name:
Other - Last Name:FELIPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:735 DULLES AVE APT 607
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5228
Mailing Address - Country:US
Mailing Address - Phone:714-483-8243
Mailing Address - Fax:
Practice Address - Street 1:602 W SEMANDS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1867
Practice Address - Country:US
Practice Address - Phone:936-756-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221482164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse