Provider Demographics
NPI:1235913807
Name:POPPEN, MONIQUE LINETTE (CNA, EMT)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:LINETTE
Last Name:POPPEN
Suffix:
Gender:F
Credentials:CNA, EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 LILAC AVE
Mailing Address - Street 2:
Mailing Address - City:OAKES
Mailing Address - State:ND
Mailing Address - Zip Code:58474-1925
Mailing Address - Country:US
Mailing Address - Phone:701-710-1726
Mailing Address - Fax:
Practice Address - Street 1:407 LILAC AVE
Practice Address - Street 2:
Practice Address - City:OAKES
Practice Address - State:ND
Practice Address - Zip Code:58474-1925
Practice Address - Country:US
Practice Address - Phone:701-710-1726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND694373747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant