Provider Demographics
NPI:1245339951
Name:MONSKE, JEANNE (CPNP)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:MONSKE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ADOBE RANCH TRL
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-4193
Mailing Address - Country:US
Mailing Address - Phone:505-437-2665
Mailing Address - Fax:
Practice Address - Street 1:1401 SUDDERTH DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6104
Practice Address - Country:US
Practice Address - Phone:575-257-7712
Practice Address - Fax:575-257-4513
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR24569363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM594365Medicare UPIN