Provider Demographics
NPI:1346237880
Name:MONKS, BRUCE DWAYNE (CRNA)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:DWAYNE
Last Name:MONKS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 SPARKS RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27020-8350
Mailing Address - Country:US
Mailing Address - Phone:336-468-1334
Mailing Address - Fax:
Practice Address - Street 1:1370 W D ST
Practice Address - Street 2:
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3506
Practice Address - Country:US
Practice Address - Phone:336-651-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC132478367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051874Medicaid
NC2606550BMedicare PIN