Provider Demographics
NPI:1285236687
Name:MONK, CHRISTOPHER (APRN)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:MONK
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 WHITE BEAR AVE N STE 104
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-4568
Mailing Address - Country:US
Mailing Address - Phone:612-444-3247
Mailing Address - Fax:612-888-9247
Practice Address - Street 1:2480 WHITE BEAR AVE N STE 104
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-4568
Practice Address - Country:US
Practice Address - Phone:612-444-3247
Practice Address - Fax:612-888-9247
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61109491363LA2200X
WAN361122516363LP2300X
MN9329363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9329OtherMN CNP LICENSE