Provider Demographics
NPI:1225686553
Name:MONTE, CAROLE MARIE
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:MARIE
Last Name:MONTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROLE
Other - Middle Name:MARIE
Other - Last Name:MORGAN- MCGRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:11441 N 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-3402
Mailing Address - Country:US
Mailing Address - Phone:623-412-4603
Mailing Address - Fax:623-412-4609
Practice Address - Street 1:11441 N 55TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-3402
Practice Address - Country:US
Practice Address - Phone:623-412-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ230680164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ230680Medicaid