Provider Demographics
NPI:1871533406
Name:CHURCH, MONICA E (CRNP)
Entity type:Individual
Prefix:MS
First Name:MONICA
Middle Name:E
Last Name:CHURCH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:MONICA
Other - Middle Name:E
Other - Last Name:CHURCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:814 ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1303
Mailing Address - Country:US
Mailing Address - Phone:215-771-0082
Mailing Address - Fax:
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:5 WOOD
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4306
Practice Address - Country:US
Practice Address - Phone:215-590-1346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP006805B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASP006805BOtherNP LICENSE NUMBER