Provider Demographics
NPI:1588784573
Name:LIDDLE, MONICA (ND, LM, CPM)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:LIDDLE
Suffix:
Gender:F
Credentials:ND, LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 W SUPERIOR ST
Mailing Address - Street 2:SUITE 502
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55802-2063
Mailing Address - Country:US
Mailing Address - Phone:218-428-0338
Mailing Address - Fax:218-740-3380
Practice Address - Street 1:31 W SUPERIOR ST
Practice Address - Street 2:SUITE 502
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2063
Practice Address - Country:US
Practice Address - Phone:218-428-0338
Practice Address - Fax:218-740-3380
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1133175F00000X
MN1019176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No175F00000XOther Service ProvidersNaturopath