MEDICARE: DORIS MONROE

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	164W00000X	Licensed Practical Nurse	PN 5146737	FL

General Provider Information

NPI Number	:	1447443502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORIS MONROE

Provider Business Mailing Address
First Line	:	1807 BARCELONA AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34946-1321
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 BARCELONA AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34946-1321
Country	:	US
Telephone Number	:	772-293-0591
Fax Number	:

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

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	08/22/2007

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Directions to “ DORIS MONROE ” Practice Location

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