Provider Demographics
NPI:1629734298
Name:THELWELL, MONIFA N
Entity Type:Individual
Prefix:
First Name:MONIFA
Middle Name:N
Last Name:THELWELL
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 1:405 N LINE ST
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2755
Mailing Address - Country:US
Mailing Address - Phone:305-978-6086
Mailing Address - Fax:800-564-5952
Practice Address - Street 1:1481 MCDONALD AVE FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-4667
Practice Address - Country:US
Practice Address - Phone:929-491-7333
Practice Address - Fax:215-714-2210
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12567363LA2200X
COAPN0999269-NP363LG0600X
PASP024065363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health