Healthcare Provider Details

I. General information

NPI: 1184453359
Provider Name (Legal Business Name): JESSICA MONROIG NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E 5TH ST
WASHINGTON MO
63090-3127
US

IV. Provider business mailing address

PO BOX 776084
CHICAGO IL
60677-6084
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-8000
  • Fax:
Mailing address:
  • Phone: 636-390-8555
  • Fax: 636-390-9444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number2024032100
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: