Provider Demographics
NPI:1801452420
Name:GASAWAY, MONICA LYNN
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LYNN
Last Name:GASAWAY
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 1:507 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-6583
Mailing Address - Country:US
Mailing Address - Phone:936-707-0888
Mailing Address - Fax:
Practice Address - Street 1:507 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-6583
Practice Address - Country:US
Practice Address - Phone:936-707-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX808186163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator