Provider Demographics
NPI:1114219094
Name:GANTIER, MONIQUE CECELIA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:CECELIA
Last Name:GANTIER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 ALBERT S
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026
Mailing Address - Country:US
Mailing Address - Phone:347-204-6090
Mailing Address - Fax:
Practice Address - Street 1:74 ALBERT ST
Practice Address - Street 2:
Practice Address - City:GARFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07026-2178
Practice Address - Country:US
Practice Address - Phone:347-204-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33 336734363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily