Provider Demographics
NPI:1891533022
Name:MONCHERRY, JAMES W (CRMP, PMTA, MA, PBT,)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:W
Last Name:MONCHERRY
Suffix:
Gender:M
Credentials:CRMP, PMTA, MA, PBT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 ADOBE DR
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-7119
Mailing Address - Country:US
Mailing Address - Phone:515-556-3518
Mailing Address - Fax:
Practice Address - Street 1:150 SE LAUREL ST
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8262
Practice Address - Country:US
Practice Address - Phone:515-556-3518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IATAT-A-3659174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist