Provider Demographics
NPI:1942081559
Name:MONROE, TAWANNA ANTONETTE
Entity Type:Individual
Prefix:MRS
First Name:TAWANNA
Middle Name:ANTONETTE
Last Name:MONROE
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 1:2330 AN COUNTY ROAD 335
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75803-1397
Mailing Address - Country:US
Mailing Address - Phone:430-800-6976
Mailing Address - Fax:
Practice Address - Street 1:2330 AN COUNTY ROAD 335
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75803-1397
Practice Address - Country:US
Practice Address - Phone:430-800-6976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24443310343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)