MEDICARE: MS. MARY REBECCA MONAGHAN APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	596032	TX
2	363LF0000X	Family Nurse Practitioner	596032	TX

General Provider Information

NPI Number	:	1003148735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY REBECCA MONAGHAN APN

Provider Business Mailing Address
First Line	:	25440 INTERSTATE 45 N
Second Line	:	SUITE 300
City	:	THE WOODLANDS
State	:	TX
Zip	:	77386-1343
Country	:	US
Telephone Number	:	281-419-1599
Fax Number	:	281-419-5885

Provider Business Practice Location Address
First Line	:	25440 INTERSTATE 45 N
Second Line	:	SUITE 300
City	:	THE WOODLANDS
State	:	TX
Zip	:	77386-1343
Country	:	US
Telephone Number	:	281-419-1599
Fax Number	:	281-419-5885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2010
Last Update Date	:	10/11/2012

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