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NPI Code Detail

MEDICARE: THERESA MONCUS RN

MEDICARE: THERESA MONCUS RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WC0400XCase Management Registered NurseRN060683GA

General Provider Information

NPI Number : 1023147063
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA MONCUS RN
Provider Business Mailing Address
First Line : 204 N WESTOVER BLVD
Second Line :
City : ALBANY
State : GA
Zip : 31707-2983
Country : US
Telephone Number : 229-888-6559
Fax Number : 229-436-4107
Provider Business Practice Location Address
First Line : 2202 E OGLETHORPE BLVD
Second Line :
City : ALBANY
State : GA
Zip : 31705-2940
Country : US
Telephone Number : 229-431-1423
Fax Number : 229-438-0738
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 07/08/2007

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