Provider Demographics
NPI:1356546089
Name:MONROE, CYNTHIA
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
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 1:1715 COUNTRY CLUB RD STE B
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6042
Mailing Address - Country:US
Mailing Address - Phone:910-238-2026
Mailing Address - Fax:910-238-2656
Practice Address - Street 1:1715 COUNTRY CLUB RD STE B
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6042
Practice Address - Country:US
Practice Address - Phone:910-238-2026
Practice Address - Fax:910-238-2656
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225000000X
NCCFM01154224900000X
NCCFO04639225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1356546089Medicaid
NC7795158Medicaid