Healthcare Provider Details

I. General information

NPI: 1972128361
Provider Name (Legal Business Name): MONICA CASTILLO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA BRAVO RN

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 S MILLER ST
WENATCHEE WA
98801-3201
US

IV. Provider business mailing address

465 N KANSAS AVE APT B
EAST WENATCHEE WA
98802-6079
US

V. Phone/Fax

Practice location:
  • Phone: 509-662-1511
  • Fax:
Mailing address:
  • Phone: 509-433-8549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN60389128
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: