Healthcare Provider Details

I. General information

NPI: 1306623574
Provider Name (Legal Business Name): ERICKA MONIGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 E RIVIERA DR
MOBILE AL
36605-2503
US

IV. Provider business mailing address

1414 E RIVIERA DR
MOBILE AL
36605-2503
US

V. Phone/Fax

Practice location:
  • Phone: 251-277-1077
  • Fax:
Mailing address:
  • Phone: 251-277-1077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number7247328
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: