Provider Demographics
NPI:1760417224
Name:MONK, JON C (PA)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:C
Last Name:MONK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3310
Mailing Address - Country:US
Mailing Address - Phone:308-384-2500
Mailing Address - Fax:308-384-2565
Practice Address - Street 1:720 N WEBB RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3310
Practice Address - Country:US
Practice Address - Phone:308-384-2500
Practice Address - Fax:308-384-2565
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE347363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE38623OtherBLUE CROSS BLUE SHIELD
NE38623OtherBLUE CROSS BLUE SHIELD
NE280042Medicare ID - Type Unspecified