Healthcare Provider Details

I. General information

NPI: 1528332855
Provider Name (Legal Business Name): MONIQUE MENSAH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONIQUE BLAIR RN

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 MARBLE AVE NE FL 2
ALBUQUERQUE NM
87106-2058
US

IV. Provider business mailing address

1157 REYNOSA LOOP SE
RIO RANCHO NM
87124-8899
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN-74035
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: