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General NPI Number Information
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NPI Number | 1790438539
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Entity Type | Individual
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Provider Name | LANETRA M MONROE CPT
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Gender | Female
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 464 E MAIN ST STE J
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City | COLUMBUS
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State | OH
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Zip | 43215-5448
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Country | US
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Telephone | 614-754-8077
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Fax |
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Provider Business Mailing Address
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Address Line | 1837 SHARBOT DR
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City | COLUMBUS
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State | OH
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Zip | 43229-5762
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Country | US
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Telephone | 419-233-5030
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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 | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | Q2L6Q8Q6
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License Number State | OH
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