Provider Demographics
NPI:1164671665
Name:GOVER, MONICA LEE (CPO)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:LEE
Last Name:GOVER
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 NEUSE BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-3449
Mailing Address - Country:US
Mailing Address - Phone:252-633-8020
Mailing Address - Fax:252-634-6912
Practice Address - Street 1:2000 NEUSE BLVD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-3449
Practice Address - Country:US
Practice Address - Phone:252-633-8020
Practice Address - Fax:252-634-6912
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCPO 1879335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0440POtherBLUE CROSS BLUE SHIELD
NC7795011Medicaid
NC0440POtherBLUE CROSS BLUE SHIELD