MEDICARE: TANGELA SHANEEN MONROE NNP-BC

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	363LN0000X	Neonatal Nurse Practitioner	0024175645	VA

General Provider Information

NPI Number	:	1487153110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANGELA SHANEEN MONROE NNP-BC

Provider Business Mailing Address
First Line	:	14088 NELSON HILL RD
Second Line	:
City	:	MILFORD
State	:	VA
Zip	:	22514-2013
Country	:	US
Telephone Number	:	804-633-1018
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 LIBBIE AVE STE 4
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-2658
Country	:	US
Telephone Number	:	804-282-8082
Fax Number	:

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

Provider Enumeration Date	:	02/08/2018
Last Update Date	:	03/22/2018

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