Provider Demographics
NPI:1386955912
Name:OUTLAW, MONICA (RN)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:OUTLAW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5284 RANDOLPH RD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2116
Mailing Address - Country:US
Mailing Address - Phone:240-475-8343
Mailing Address - Fax:301-890-3522
Practice Address - Street 1:5284 RANDOLPH RD
Practice Address - Street 2:SUITE 124
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2116
Practice Address - Country:US
Practice Address - Phone:240-475-8343
Practice Address - Fax:301-890-3522
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN62936163W00000X, 163WC0400X, 171M00000X, 172V00000X, 174H00000X, 372600000X
MDRN119781163WA2000X
MDR119781163WC0400X, 163WC1600X, 163WH0200X, 163W00000X, 171M00000X, 172V00000X, 174H00000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No172V00000XOther Service ProvidersCommunity Health Worker
No174H00000XOther Service ProvidersHealth Educator
No372600000XNursing Service Related ProvidersAdult Companion