Individual
MONIQUE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17927 N PARKVIEW PL, SURPRISE, AZ 85374-3441
(708) 595-6884
Mailing address
17927 N PARKVIEW PL, SURPRISE, AZ 85374-3441
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP047264
AZ
Other
Enumeration date
08/20/2015
Last updated
08/20/2015
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