Provider Demographics
NPI:1881722916
Name:MONIC, BERTHA PAIGE (RN058886)
Entity type:Individual
Prefix:MS
First Name:BERTHA
Middle Name:PAIGE
Last Name:MONIC
Suffix:
Gender:F
Credentials:RN058886
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 CAVANESS DR
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70364-2201
Mailing Address - Country:US
Mailing Address - Phone:985-872-0790
Mailing Address - Fax:
Practice Address - Street 1:2632 HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:LABADIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70372-2045
Practice Address - Country:US
Practice Address - Phone:985-526-1699
Practice Address - Fax:985-526-6796
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN058886163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse