Provider Demographics
NPI:1639297864
Name:MONROE, PRISCILLA JO (ND)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:JO
Last Name:MONROE
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 J ST STE 205
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3839
Mailing Address - Country:US
Mailing Address - Phone:916-448-9927
Mailing Address - Fax:
Practice Address - Street 1:5025 J ST STE 205
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3839
Practice Address - Country:US
Practice Address - Phone:916-448-9927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND60175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath