Provider Demographics
NPI:1366836843
Name:MONSON, ANDREW NOLAN (DO)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:NOLAN
Last Name:MONSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 POLE LINE RD W STE 111
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-5819
Mailing Address - Country:US
Mailing Address - Phone:208-814-8000
Mailing Address - Fax:208-733-9402
Practice Address - Street 1:775 POLE LINE RD W STE 111
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-5819
Practice Address - Country:US
Practice Address - Phone:208-814-8000
Practice Address - Fax:208-733-9402
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
IDO-1371208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program