Healthcare Provider Details

I. General information

NPI: 1518074327
Provider Name (Legal Business Name): JANICE K MONROE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 SW HWY 97 SUITE 101
MADRAS OR
97741
US

IV. Provider business mailing address

910 SW HWY 97 SUITE 101
MADRAS OR
97741
US

V. Phone/Fax

Practice location:
  • Phone: 541-475-7800
  • Fax: 541-475-6600
Mailing address:
  • Phone: 541-454-2888
  • Fax: 541-454-2988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number087003014
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: