Basic Information
| Provider Information | |||||||||
| NPI: | 1508345893 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONROE | ||||||||
| FirstName: | SABRINA | ||||||||
| MiddleName: | KAYE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975012756 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412002423 | ||||||||
| FaxNumber: | 5417342410 | ||||||||
| Practice Location | |||||||||
| Address1: | 209 W MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MEDFORD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 975012728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412002423 | ||||||||
| FaxNumber: | 5417342410 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2018 | ||||||||
| LastUpdateDate: | 08/08/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 175T00000X | OR | N | 247000000X | OR | Y | Technologists, Technicians & Other Technical Service Providers | Technician, Health Information |
No ID Information.