Provider Demographics
NPI:1962452839
Name:MONACO, RALPH JR (CRNA)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:MONACO
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 MACARTHUR BOULEVARD
Mailing Address - Street 2:ANESTHESIA DEPARTMENT
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2901
Mailing Address - Country:US
Mailing Address - Phone:219-836-7040
Mailing Address - Fax:219-513-1127
Practice Address - Street 1:901 MACARTHUR BOULEVARD
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3901
Practice Address - Country:US
Practice Address - Phone:219-836-1600
Practice Address - Fax:219-513-1127
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28151381A174400000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000203434OtherANTHEM BCBS
IL036079113Medicaid
IN200382350AMedicaid
IN000000203434OtherANTHEM BCBS
INOTH000Medicare UPIN