Healthcare Provider Details

I. General information

NPI: 1043724743
Provider Name (Legal Business Name): MRS. ANN MONKEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2017
Last Update Date: 02/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 N 4TH ST
TERRE HAUTE IN
47804
US

IV. Provider business mailing address

1739 N 4TH ST
TERRE HAUTE IN
47804-4002
US

V. Phone/Fax

Practice location:
  • Phone: 812-242-3600
  • Fax:
Mailing address:
  • Phone: 812-242-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007743A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: