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NPI Code Detail

MEDICARE: MONIQUE MARTY FNP

MEDICARE: MONIQUE MARTY 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
1363L00000XNurse PractitionerRN114496TN
2363LF0000XFamily Nurse PractitionerAPN10995TN

General Provider Information

NPI Number : 1700971231
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONIQUE MARTY FNP
Provider Business Mailing Address
First Line : 1021 W OAKLAND AVE
Second Line : SUITE 207
City : JOHNSON CITY
State : TN
Zip : 37604-2191
Country : US
Telephone Number : 423-916-5106
Fax Number : 423-952-3109
Provider Business Practice Location Address
First Line : 403 N STATE OF FRANKLIN RD
Second Line :
City : JOHNSON CITY
State : TN
Zip : 37604-6034
Country : US
Telephone Number : 423-431-7111
Fax Number : 423-431-7092
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2006
Last Update Date : 11/05/2009

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Directions to “ MONIQUE MARTY FNP” Practice Location

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