Provider Demographics
NPI:1427620699
Name:ALLLEN, MONJUE (PHLEBOTOMY/ MEDICAL)
Entity type:Individual
Prefix:
First Name:MONJUE
Middle Name:
Last Name:ALLLEN
Suffix:
Gender:F
Credentials:PHLEBOTOMY/ MEDICAL
Other - Prefix:
Other - First Name:MONJUE
Other - Middle Name:
Other - Last Name:ALLLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:8439 TOLEDO AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-2200
Mailing Address - Country:US
Mailing Address - Phone:763-703-0326
Mailing Address - Fax:
Practice Address - Street 1:8439 TOLEDO AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-2200
Practice Address - Country:US
Practice Address - Phone:763-703-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1677-158-707-8729305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service