| Doctor Name: | MONIQUE THAMMAVONG |
| NPI Number: | 1275932253 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN, NP-C |
| License Number: | A004175 |
| Business Practice Address: | 14 Gothic Ridge Rd Van Buren, AR - 729566565 |
| Business Phone Number: | 4794741100 |
| Business Fax Number: | |
| Mailing Address: | 110 S 42nd St, VAN BUREN |
| State: | AR |
| Postal Code: | 729565614 |
| Phone Number: | 4794201554 |
| Fax Number: | |
| NPI Enumeration Date: | 08/15/2014 |
| NPI Last Update Date: | 08/15/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | A004175 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |