Healthcare Provider Details
I. General information
NPI: 1295243822
Provider Name (Legal Business Name): MONICA LEIGH IVERSON APRN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 01/17/2018
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2818 ASTORIA BLVD
ASTORIA NY
11102-1932
US
IV. Provider business mailing address
2818 ASTORIA BLVD
ASTORIA NY
11102-1932
US
V. Phone/Fax
- Phone: 917-410-6905
- Fax: 347-889-7346
- Phone: 917-410-6905
- Fax: 347-889-7346
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363LW0102X |
| Taxonomy | Women's Health Nurse Practitioner |
| License Number | 421327 |
| License Number State | NY |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: