Provider Demographics
NPI:1669142063
Name:MONK, MAXIE L
Entity type:Individual
Prefix:
First Name:MAXIE
Middle Name:L
Last Name:MONK
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:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:MULLENS
Mailing Address - State:WV
Mailing Address - Zip Code:25882-0106
Mailing Address - Country:US
Mailing Address - Phone:304-294-8241
Mailing Address - Fax:
Practice Address - Street 1:4042 HERNDON RD
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:WV
Practice Address - Zip Code:24726-9301
Practice Address - Country:US
Practice Address - Phone:304-294-8241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant