Provider Demographics
NPI:1437447976
Name:GARBER, MONIQUE D (PA-C)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:D
Last Name:GARBER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 KIMBALL DR UNIT 125
Mailing Address - Street 2:
Mailing Address - City:HOOKSETT
Mailing Address - State:NH
Mailing Address - Zip Code:03106-2604
Mailing Address - Country:US
Mailing Address - Phone:603-232-8902
Mailing Address - Fax:603-647-8593
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7559
Practice Address - Country:US
Practice Address - Phone:603-224-2556
Practice Address - Fax:603-226-5821
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1805363A00000X
KYTC204363AM0700X
KYPA1812363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK105980Medicare PIN