Provider Demographics
NPI:1154143634
Name:MONKAM, AUDREY NABILA
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:NABILA
Last Name:MONKAM
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:PO BOX 20125
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-0125
Mailing Address - Country:US
Mailing Address - Phone:952-245-2594
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 20125
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73156-0125
Practice Address - Country:US
Practice Address - Phone:952-245-2594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist