Provider Demographics
NPI:1588230635
Name:MONKEN, MICHELLE RENE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENE
Last Name:MONKEN
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 1:100 KINGSTON TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-1399
Mailing Address - Country:US
Mailing Address - Phone:618-792-3918
Mailing Address - Fax:
Practice Address - Street 1:294 KINGS RIDGE BLVD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-6330
Practice Address - Country:US
Practice Address - Phone:618-975-3781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-31
Last Update Date:2021-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide