Provider Demographics
NPI:1053962530
Name:BROTEN, MONICA GAIL
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:GAIL
Last Name:BROTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:GAIL
Other - Last Name:TRIEBENBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30840 TIGER STREET NW
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371
Mailing Address - Country:US
Mailing Address - Phone:763-389-7841
Mailing Address - Fax:
Practice Address - Street 1:30840 TIGER STREET NW
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371
Practice Address - Country:US
Practice Address - Phone:763-389-7841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider