Provider Demographics
NPI:1821664442
Name:TURNER, MONA M
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:M
Last Name:TURNER
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 1:4221 N 19TH ST LOWR
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-6829
Mailing Address - Country:US
Mailing Address - Phone:414-400-1400
Mailing Address - Fax:
Practice Address - Street 1:4221 N 19TH ST LOWR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-6829
Practice Address - Country:US
Practice Address - Phone:414-400-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0209266347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle