Provider Demographics
NPI:1447963012
Name:PRINCE, MONIQUE ANNETTE
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:ANNETTE
Last Name:PRINCE
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 1:11408 LAKE SHERWOOD AVE N STE A
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-0421
Mailing Address - Country:US
Mailing Address - Phone:225-261-7143
Mailing Address - Fax:225-250-1026
Practice Address - Street 1:11408 LAKE SHERWOOD AVE N STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-0421
Practice Address - Country:US
Practice Address - Phone:225-261-7143
Practice Address - Fax:225-250-1026
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator