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General NPI Number Information
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NPI Number | 1568936847
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Entity Type | Individual
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Provider Name | ANNETTE DIANE MONK MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 01/19/2019
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Last Update Date | 01/19/2019
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Provider Practice Location Address
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Address Line | 2065 HALF DAY RD
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City | DEERFIELD
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State | IL
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Zip | 60015-1241
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Country | US
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Telephone | 815-383-3271
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Fax |
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Provider Business Mailing Address
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Address Line | 9 W RUSTIC LN
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City | ROUND LAKE BEACH
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State | IL
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Zip | 60073-4059
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Country | US
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Telephone | 815-383-3271
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1798
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096002385
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License Number State | IL
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