Healthcare Provider Details

I. General information

NPI: 1245339951
Provider Name (Legal Business Name): JEANNE MONSKE C.P.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SUDDERTH DR
RUIDOSO NM
88345-6104
US

IV. Provider business mailing address

30 ADOBE RANCH TRL
ALAMOGORDO NM
88310-4193
US

V. Phone/Fax

Practice location:
  • Phone: 575-257-7712
  • Fax: 575-257-4513
Mailing address:
  • Phone: 505-437-2665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR24569
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: