Individual
MRS. MONICA VICKERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2313 MAMMOTH GROVE RD, LAKE WALES, FL 33898-8583
(863) 206-6439
Mailing address
2313 MAMMOTH GROVE RD, LAKE WALES, FL 33898-8583
(863) 206-6439
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
6906570
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006792400
—
FL
Enumeration date
09/06/2013
Last updated
09/06/2013
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