Provider Demographics
NPI:1790438539
Name:MONROE, LANETRA M (CPT)
Entity Type:Individual
Prefix:
First Name:LANETRA
Middle Name:M
Last Name:MONROE
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 SHARBOT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5762
Mailing Address - Country:US
Mailing Address - Phone:419-233-5030
Mailing Address - Fax:
Practice Address - Street 1:464 E MAIN ST STE J
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5448
Practice Address - Country:US
Practice Address - Phone:614-754-8077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHQ2L6Q8Q6202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology