Healthcare Provider Details

I. General information

NPI: 1225797624
Provider Name (Legal Business Name): ALLURA MCMONIGAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2021
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 COLLINS AVE
MANDAN ND
58554-2066
US

IV. Provider business mailing address

1200 COLLINS AVE
MANDAN ND
58554-2066
US

V. Phone/Fax

Practice location:
  • Phone: 701-355-6845
  • Fax:
Mailing address:
  • Phone: 701-355-6845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR51076
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: