Provider Demographics
NPI:1689171530
Name:GROUX, MONIQUE SUSANNE
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:SUSANNE
Last Name:GROUX
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 1:313 LEONARD ST
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-3332
Mailing Address - Country:US
Mailing Address - Phone:860-951-9804
Mailing Address - Fax:
Practice Address - Street 1:313 LEONARD ST
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-3332
Practice Address - Country:US
Practice Address - Phone:860-951-9804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-08
Last Update Date:2018-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program