Healthcare Provider Details

I. General information

NPI: 1952016370
Provider Name (Legal Business Name): MONA MIX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2023
Last Update Date: 07/20/2023
Certification Date: 07/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5822 S LOWELL WAY
LITTLETON CO
80123-2849
US

IV. Provider business mailing address

PO BOX 140823
BROKEN ARROW OK
74014-0008
US

V. Phone/Fax

Practice location:
  • Phone: 720-669-3470
  • Fax: 720-669-3480
Mailing address:
  • Phone: 918-824-9011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number211090
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-APN.01010403-C-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: