Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0122X | Plastic and Reconstructive Surgery | BP10047437 | TX |
Y | 2086S0122X | Plastic and Reconstructive Surgery | MD192408 | OR |
NPI | 1023455490 |
---|---|
Provider Name | Sharon Elaine Monsivais |
First Address | Coos Bay, OR 97420-2099 |
Second Address | Coos Bay, OR 97420-2099 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2013 |
Last Update Date | 05/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500767377 | (05) | OR |