Provider Demographics
NPI:1013229038
Name:MONROE, URSULA M (L AC)
Entity Type:Individual
Prefix:MS
First Name:URSULA
Middle Name:M
Last Name:MONROE
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17513 DERBY WAY
Mailing Address - Street 2:
Mailing Address - City:PENN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95946-9725
Mailing Address - Country:US
Mailing Address - Phone:530-432-8227
Mailing Address - Fax:
Practice Address - Street 1:10524 SPENCEVILLE RD STE C-1
Practice Address - Street 2:
Practice Address - City:PENN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95946-9623
Practice Address - Country:US
Practice Address - Phone:530-432-8227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9601171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist