Provider Demographics
NPI:1952945438
Name:SPEARS, MONIQUE MARTHA (APRN)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:MARTHA
Last Name:SPEARS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 N BEADLE DR
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1077
Mailing Address - Country:US
Mailing Address - Phone:773-450-7203
Mailing Address - Fax:
Practice Address - Street 1:1520 KENSINGTON RD
Practice Address - Street 2:STE 212
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2139
Practice Address - Country:US
Practice Address - Phone:888-562-5442
Practice Address - Fax:844-861-1929
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAN261125370363LF0000X
IL209019985363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily