Provider Demographics
NPI:1073716429
Name:MONUTEAUX, JEANNINE ELIZABETH (LMP)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:ELIZABETH
Last Name:MONUTEAUX
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37231 VEAZIE CUMBERLAND RD SE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-8724
Mailing Address - Country:US
Mailing Address - Phone:360-761-9706
Mailing Address - Fax:
Practice Address - Street 1:1525 COLE ST STE 3
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3020
Practice Address - Country:US
Practice Address - Phone:360-761-9706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00024220174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist