Provider Demographics
NPI:1114197654
Name:ESTES, MONA
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:ESTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 N ROAD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3283
Mailing Address - Country:US
Mailing Address - Phone:252-333-1149
Mailing Address - Fax:757-338-6503
Practice Address - Street 1:1507 N ROAD ST STE 2
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3283
Practice Address - Country:US
Practice Address - Phone:252-333-1149
Practice Address - Fax:252-338-6503
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024055680363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily