Provider Demographics
NPI:1487946380
Name:RENDON, MONICA K (LMBT)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:K
Last Name:RENDON
Suffix:
Gender:F
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 LANGHORNE DR
Mailing Address - Street 2:
Mailing Address - City:MT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-1452
Mailing Address - Country:US
Mailing Address - Phone:704-421-2006
Mailing Address - Fax:704-820-8043
Practice Address - Street 1:320 LANGHORNE DR
Practice Address - Street 2:
Practice Address - City:MT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-1452
Practice Address - Country:US
Practice Address - Phone:704-421-2006
Practice Address - Fax:704-820-8043
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10692174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist