Provider Demographics
NPI:1104428655
Name:MONARI, ELLEN GESARE
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:GESARE
Last Name:MONARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5006 VERA CRUZ AVE N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3082
Mailing Address - Country:US
Mailing Address - Phone:612-598-5079
Mailing Address - Fax:
Practice Address - Street 1:234 BROADWAY ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1902
Practice Address - Country:US
Practice Address - Phone:612-724-8580
Practice Address - Fax:612-724-8580
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2482478163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse