Healthcare Provider Details

I. General information

NPI: 1316289903
Provider Name (Legal Business Name): JO ANNA LEA MONROE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 12/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 JAMES HOVATER RD
RUSSELLVILLE AL
35653-8004
US

IV. Provider business mailing address

PO BOX 626
RUSSELLVILLE AL
35653-0626
US

V. Phone/Fax

Practice location:
  • Phone: 256-332-6208
  • Fax: 256-332-6213
Mailing address:
  • Phone: 256-332-6208
  • Fax: 256-332-6213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-090589
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: