Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | OS10132 | FL |
N | 2080P0205X | Pediatric Endocrinologist | 036-111969 | IL |
Y | 2080P0205X | Pediatric Endocrinologist | OS10132 | FL |
NPI | 1104869254 |
---|---|
Provider Name | Dr. Monica Mortensen |
First Address | Rockland, DE 19732-0191 |
Second Address | Jacksonville, FL 32207-8426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 10/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10140 | BCBS (01) | FL |
280412300 | (05) | FL |
362169147 | (02) | IL |
362169147 | (05) | IL |
OS10132 | LICENSE (01) | FL |