Provider Demographics
NPI:1114575545
Name:KARRIEM, MONICA ELISE
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ELISE
Last Name:KARRIEM
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 1:291 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01013-2837
Mailing Address - Country:US
Mailing Address - Phone:860-983-9594
Mailing Address - Fax:
Practice Address - Street 1:291 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01013-2837
Practice Address - Country:US
Practice Address - Phone:860-983-9594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program