Healthcare Provider Details

I. General information

NPI: 1457326456
Provider Name (Legal Business Name): JOSHUA MICHAEL MONDAY CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 LEXINGTON AVE
ASHLAND KY
41101-2843
US

IV. Provider business mailing address

3785 RELIABLE PARKWAY
CHICAGO IL
60686-0001
US

V. Phone/Fax

Practice location:
  • Phone: 606-327-4000
  • Fax:
Mailing address:
  • Phone: 316-281-3700
  • Fax: 316-282-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4212A
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: