Healthcare Provider Details

I. General information

NPI: 1992494959
Provider Name (Legal Business Name): MONICA LYNNE EUGENIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5337 W GRANDE MARKET DR
APPLETON WI
54913-8442
US

IV. Provider business mailing address

119 N MCCARTHY RD STE S
APPLETON WI
54913-9111
US

V. Phone/Fax

Practice location:
  • Phone: 920-731-7445
  • Fax: 920-882-2946
Mailing address:
  • Phone: 920-750-6374
  • Fax: 920-404-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number600223615
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: