MEDICARE: JO ANNA LEA MONROE CRNP

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	363LF0000X	Family Nurse Practitioner	1-090589	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NPI	OTHER	AL	1316289903
2	1326373861	OTHER	AL	GROUP NPI

General Provider Information

NPI Number	:	1316289903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JO ANNA LEA MONROE CRNP

Provider Business Mailing Address
First Line	:	PO BOX 626
Second Line	:
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-0626
Country	:	US
Telephone Number	:	256-332-6208
Fax Number	:	256-332-6213

Provider Business Practice Location Address
First Line	:	101 JAMES HOVATER RD
Second Line	:
City	:	RUSSELLVILLE
State	:	AL
Zip	:	35653-8004
Country	:	US
Telephone Number	:	256-332-6208
Fax Number	:	256-332-6213

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

Provider Enumeration Date	:	03/21/2013
Last Update Date	:	12/16/2014

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