Healthcare Provider Details

I. General information

NPI: 1326262981
Provider Name (Legal Business Name): MONICA EGGLESTON RN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 371 JUNCTION ROUTE 9
CROWNPOINT NM
87313-0358
US

IV. Provider business mailing address

PO BOX 358
CROWNPOINT NM
87313-0358
US

V. Phone/Fax

Practice location:
  • Phone: 505-786-5291
  • Fax: 505-786-6440
Mailing address:
  • Phone: 505-786-5291
  • Fax: 505-786-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30007619
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: