Basic Information
| Provider Information | |||||||||
| NPI: | 1003148735 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MONAGHAN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | REBECCA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25440 INTERSTATE 45 N | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773861343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814191599 | ||||||||
| FaxNumber: | 2814195885 | ||||||||
| Practice Location | |||||||||
| Address1: | 25440 INTERSTATE 45 N | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773861343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2814191599 | ||||||||
| FaxNumber: | 2814195885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2010 | ||||||||
| LastUpdateDate: | 10/11/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | 596032 | TX | N | Nursing Service Providers | Registered Nurse | General Practice | 363LF0000X | 596032 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.