Provider Demographics
NPI:1891450094
Name:GARVANIAN, MONIQUE LYNNE (RN)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:LYNNE
Last Name:GARVANIAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 KAWANA SPRINGS RD APT 208
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-1867
Mailing Address - Country:US
Mailing Address - Phone:650-293-7197
Mailing Address - Fax:
Practice Address - Street 1:2403 PROFESSIONAL DR # 203
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3007
Practice Address - Country:US
Practice Address - Phone:707-571-2233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA475626163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)