Provider Demographics
NPI:1073717690
Name:MONOROM, CONNOR HANG (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:HANG
Last Name:MONOROM
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16876 JASPER PATH
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5679
Mailing Address - Country:US
Mailing Address - Phone:952-702-4269
Mailing Address - Fax:
Practice Address - Street 1:16876 JASPER PATH
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55044-5679
Practice Address - Country:US
Practice Address - Phone:952-702-4269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 141319-1163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health