| Doctor Name: | MONICA IBANEZ |
| NPI Number: | 1093125361 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CPNP |
| License Number: | RN173287 |
| Business Practice Address: | 9280 Highway 5 Suite A Douglasville, GA - 301341501 |
| Business Phone Number: | 7709425863 |
| Business Fax Number: | 7704894593 |
| Mailing Address: | 3670 Bardfield Ct, CUMMING |
| State: | GA |
| Postal Code: | 300417332 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/07/2014 |
| NPI Last Update Date: | 01/14/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | RN173287 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |