Provider Demographics
NPI:1578271524
Name:MINOR, MONIQUE EVETTE
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:EVETTE
Last Name:MINOR
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 1:39403 GERMANY RD
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-5020
Mailing Address - Country:US
Mailing Address - Phone:225-313-8531
Mailing Address - Fax:
Practice Address - Street 1:39403 GERMANY RD
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-5020
Practice Address - Country:US
Practice Address - Phone:225-313-8531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)