Provider Demographics
NPI:1689927691
Name:RASH, MONIQUE SHANTAE (NP-C)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:SHANTAE
Last Name:RASH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:SHANTAE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:RR 103 SUPPLY STREET
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:WV
Mailing Address - Zip Code:24836-0507
Mailing Address - Country:US
Mailing Address - Phone:304-448-2101
Mailing Address - Fax:304-448-3217
Practice Address - Street 1:US RT 52 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORTHFORK
Practice Address - State:WV
Practice Address - Zip Code:24868
Practice Address - Country:US
Practice Address - Phone:304-862-5288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-16
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170402363LF0000X
WV71598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV003044610OtherHIGHMARK BCBS OF WEST VIRGINIA
WV3810027334Medicaid
WV003044610OtherHIGHMARK BCBS OF WEST VIRGINIA
WVWV4077BMedicare PIN
WVWV4077AMedicare PIN