Healthcare Provider Details

I. General information

NPI: 1437380482
Provider Name (Legal Business Name): NANCY LEE MCMONIGLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY LEE HARRIS RN

II. Dates (important events)

Enumeration Date: 08/06/2009
Last Update Date: 04/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CENTRAL AVE (ATT. KRISTI HIAPO)
JBPHH HI
96860-4908
US

IV. Provider business mailing address

480 CENTRAL AVE (ATT. KRISTI HIAPO)
JBPHH HI
96860-4908
US

V. Phone/Fax

Practice location:
  • Phone: 808-471-1866
  • Fax:
Mailing address:
  • Phone: 808-471-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number416339-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2080512
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number655405
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number34265
License Number StateMT
# 5
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number63436
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: