Provider Demographics
NPI:1114493723
Name:MAGOWAN, MONICA MARIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:MARIE
Last Name:MAGOWAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:MONICA
Other - Middle Name:MARIE
Other - Last Name:STECHMULLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:163 E BETHALTO DR
Mailing Address - Street 2:
Mailing Address - City:BETHALTO
Mailing Address - State:IL
Mailing Address - Zip Code:62010-1801
Mailing Address - Country:US
Mailing Address - Phone:618-433-6640
Mailing Address - Fax:
Practice Address - Street 1:163 E BETHALTO DR
Practice Address - Street 2:
Practice Address - City:BETHALTO
Practice Address - State:IL
Practice Address - Zip Code:62010-1801
Practice Address - Country:US
Practice Address - Phone:618-433-6640
Practice Address - Fax:618-433-6645
Is Sole Proprietor?:No
Enumeration Date:2018-10-22
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018014818363LF0000X
IL209017601363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily