Provider Demographics
NPI:1821754565
Name:MONGER, CHRISTINA J (LPN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:J
Last Name:MONGER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:MONGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:961 VAN DUZER ST APT 1B1
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304-1863
Mailing Address - Country:US
Mailing Address - Phone:347-791-6557
Mailing Address - Fax:
Practice Address - Street 1:26 DUMONT AVE FL 1
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1450
Practice Address - Country:US
Practice Address - Phone:347-791-6557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY342040-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty