Provider Demographics
NPI:1053998724
Name:MITCHELL-MONROE, TERESA L (RN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:MITCHELL-MONROE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 HIDDEN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2318
Mailing Address - Country:US
Mailing Address - Phone:903-908-2195
Mailing Address - Fax:
Practice Address - Street 1:1404 HIDDEN GLEN DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2318
Practice Address - Country:US
Practice Address - Phone:903-908-2195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX621211163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool