Provider Demographics
NPI:1851697627
Name:MONK, GLENNA DOMANTAY (NP)
Entity Type:Individual
Prefix:
First Name:GLENNA
Middle Name:DOMANTAY
Last Name:MONK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:924 WESTWOOD BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-2924
Mailing Address - Country:US
Mailing Address - Phone:310-794-8325
Mailing Address - Fax:310-983-3574
Practice Address - Street 1:924 WESTWOOD BLVD STE 320
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-2924
Practice Address - Country:US
Practice Address - Phone:310-794-8325
Practice Address - Fax:310-983-3574
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15816363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner