Provider Demographics
NPI:1295146850
Name:ANDERSON, MONICA (CA)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3614 GREENBRIAR DR NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-2512
Mailing Address - Country:US
Mailing Address - Phone:256-886-0842
Mailing Address - Fax:
Practice Address - Street 1:417 JORDAN LN NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-2623
Practice Address - Country:US
Practice Address - Phone:256-886-0842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL122023174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist