MEDICARE: CARRIE MONROE

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
1	164X00000X	Licensed Vocational Nurse	306957	TX

General Provider Information

NPI Number	:	1477016541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARRIE MONROE

Provider Business Mailing Address
First Line	:	2524 KIRKLEY ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-4829
Country	:	US
Telephone Number	:	214-600-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	2524 KIRKLEY ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75241-4829
Country	:	US
Telephone Number	:	214-600-6060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/07/2019
Last Update Date	:	06/14/2022

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Directions to “ CARRIE MONROE ” Practice Location

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