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NPI Code Detail

MEDICARE: JON C MONK PA

MEDICARE: JON C MONK PA
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
1363A00000XPhysician Assistant347NE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
138623OTHERNEBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1760417224
Entity Type Code : Individual
Provider Name (Legal Business Name) : JON C MONK PA
Provider Business Mailing Address
First Line : 720 N WEBB RD
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68803-3310
Country : US
Telephone Number : 308-384-2500
Fax Number : 308-384-2565
Provider Business Practice Location Address
First Line : 720 N WEBB RD
Second Line :
City : GRAND ISLAND
State : NE
Zip : 68803-3310
Country : US
Telephone Number : 308-384-2500
Fax Number : 308-384-2565
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2006
Last Update Date : 04/23/2014

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Directions to “ JON C MONK PA” Practice Location

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