Provider Demographics
NPI:1306623574
Name:MONIGAN, ERICKA
Entity type:Individual
Prefix:
First Name:ERICKA
Middle Name:
Last Name:MONIGAN
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 1:1414 E RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36605-2503
Mailing Address - Country:US
Mailing Address - Phone:251-277-1077
Mailing Address - Fax:
Practice Address - Street 1:1414 E RIVIERA DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36605-2503
Practice Address - Country:US
Practice Address - Phone:251-277-1077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7247328172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver