Provider Demographics
NPI:1881862795
Name:NILSEN, MONIQUE ROCHELLE
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:ROCHELLE
Last Name:NILSEN
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:PO BOX 11526
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92711-1526
Mailing Address - Country:US
Mailing Address - Phone:714-567-5183
Mailing Address - Fax:714-567-7633
Practice Address - Street 1:1300 S GRAND AVE STE C
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4434
Practice Address - Country:US
Practice Address - Phone:714-567-5183
Practice Address - Fax:714-567-7633
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator