Provider Demographics
NPI:1669440426
Name:MONASTESSE, MARY E (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:MONASTESSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 660599
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75266-0599
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1936 AMELIA CT
Practice Address - Street 2:HIV/AIDS CLINIC
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-7711
Practice Address - Country:US
Practice Address - Phone:214-590-5637
Practice Address - Fax:214-590-2832
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX572932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149906303Medicaid
TX8Y0045OtherBLUE CROSS BLUE SHIELD
TXP54461Medicare UPIN
8G3919Medicare PIN