Provider Demographics
NPI:1023101383
Name:MONCRIEF, AUBREY FOLSOM (CRNA)
Entity type:Individual
Prefix:MR
First Name:AUBREY
Middle Name:FOLSOM
Last Name:MONCRIEF
Suffix:
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:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:OSAGE BEACH
Mailing Address - State:MO
Mailing Address - Zip Code:65065-0264
Mailing Address - Country:US
Mailing Address - Phone:573-302-0836
Mailing Address - Fax:573-302-0863
Practice Address - Street 1:5470 STONE LEDGE CIR
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-2554
Practice Address - Country:US
Practice Address - Phone:573-302-0836
Practice Address - Fax:573-302-0863
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO084548367500000X
IL209-001689367500000X
MI4704131876367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO917422107Medicaid
MOMA1170002Medicare PIN
MOJ11B553Medicare PIN
MOP00295287Medicare PIN
MOS55B553Medicare PIN