Healthcare Provider Details

I. General information

NPI: 1265691679
Provider Name (Legal Business Name): MONTRICIA LEWIS MONROE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 N ELM ST
GREENSBORO NC
27455-2593
US

IV. Provider business mailing address

210 WESTWOOD PL STE 300
BRENTWOOD TN
37027-7554
US

V. Phone/Fax

Practice location:
  • Phone: 866-686-2504
  • Fax:
Mailing address:
  • Phone: 866-686-2504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5003972
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: