MEDICARE: MS. LE'STARR MONIQUE ROSE FNP

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	F10230750	NC
2	163W00000X	Registered Nurse	239661	NC
3	363L00000X	Nurse Practitioner	5019213	NC

General Provider Information

NPI Number	:	1619391109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LE'STARR MONIQUE ROSE FNP

Provider Business Mailing Address
First Line	:	510 N ELAM AVE STE 202
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27403-1177
Country	:	US
Telephone Number	:	336-299-3183
Fax Number	:	336-313-2526

Provider Business Practice Location Address
First Line	:	5106 BARTHOLOMEWS LN
Second Line	:
City	:	GREENSBORO
State	:	NC
Zip	:	27407-2726
Country	:	US
Telephone Number	:	336-609-9105
Fax Number	:	336-313-2526

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

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	06/09/2026

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