Individual
DR. CARLA G MONICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-5970
(601) 984-5902
Mailing address
2500 N STATE ST, DIVISION OF NEPHROLOGY, JACKSON, MS 39216-4500
(601) 984-5970
(601) 984-5902
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
38268
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02623513
—
MS
01
—
110129725
RAIL ROAD MEDICARE
MN
05
—
35334600
—
WI
05
—
525013700
—
MN
05
—
ENROLLED
—
IA
01
—
P01436115
RAILROAD MEDICARE
MS
Enumeration date
02/14/2006
Last updated
01/06/2016
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