Provider Demographics
NPI:1225733728
Name:MONROE, MICHELLE YVETTE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:YVETTE
Last Name:MONROE
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 1:218 W CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-3704
Mailing Address - Country:US
Mailing Address - Phone:918-291-6710
Mailing Address - Fax:
Practice Address - Street 1:218 W CYPRESS ST
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-3704
Practice Address - Country:US
Practice Address - Phone:918-291-6710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist