Provider Demographics
NPI:1326702119
Name:MONGAR, MONI
Entity Type:Individual
Prefix:
First Name:MONI
Middle Name:
Last Name:MONGAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 22ND ST S APT 204
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-2993
Mailing Address - Country:US
Mailing Address - Phone:701-541-6719
Mailing Address - Fax:
Practice Address - Street 1:4810 16TH AVE S APT 306
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3292
Practice Address - Country:US
Practice Address - Phone:701-541-6719
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant