Provider Demographics
NPI:1952016370
Name:MIX, MONA
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:
Last Name:MIX
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:PO BOX 140823
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-0008
Mailing Address - Country:US
Mailing Address - Phone:918-824-9011
Mailing Address - Fax:
Practice Address - Street 1:5822 S LOWELL WAY
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-2849
Practice Address - Country:US
Practice Address - Phone:720-669-3470
Practice Address - Fax:720-669-3480
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK211090363LF0000X
COC-APN.01010403-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily