1659737740 NPI number — VONZOLLA MONIQUE ELLIOTT

Table of content: VONZOLLA MONIQUE ELLIOTT (NPI 1659737740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659737740 NPI number — VONZOLLA MONIQUE ELLIOTT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ELLIOTT
Provider First Name:
VONZOLLA
Provider Middle Name:
MONIQUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659737740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8515 BOULEVARD 26 APT 209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH RICHLAND HILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76180-5632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-289-1067
Provider Business Mailing Address Fax Number:
317-723-3632

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
429 E VERMONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-3690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-723-3181
Provider Business Practice Location Address Fax Number:
317-723-3632
Provider Enumeration Date:
01/06/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  6801092790 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 34007952A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: LW60750646 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)