Provider Demographics
NPI:1144380148
Name:CLASS, MONIQUE TERESA (APRN)
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:TERESA
Last Name:CLASS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:MONIQUE
Other - Middle Name:TERESA
Other - Last Name:CASSETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1011 HIGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1610
Mailing Address - Country:US
Mailing Address - Phone:203-321-0200
Mailing Address - Fax:203-321-0300
Practice Address - Street 1:1011 HIGH RIDGE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1610
Practice Address - Country:US
Practice Address - Phone:203-321-0200
Practice Address - Fax:203-321-0300
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002776363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
D98417Medicare UPIN