Provider Demographics
NPI:1699367318
Name:MONSON, ALLY CLAIRE
Entity Type:Individual
Prefix:
First Name:ALLY
Middle Name:CLAIRE
Last Name:MONSON
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 1:5918 RIDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MOUND
Mailing Address - State:MN
Mailing Address - Zip Code:55364-8571
Mailing Address - Country:US
Mailing Address - Phone:701-388-1126
Mailing Address - Fax:
Practice Address - Street 1:5918 RIDGEWOOD RD
Practice Address - Street 2:
Practice Address - City:MOUND
Practice Address - State:MN
Practice Address - Zip Code:55364-8571
Practice Address - Country:US
Practice Address - Phone:701-388-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN820573164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse