MEDICARE: MRS. MONICA RAQUEL BYERS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WG0000X	General Practice Registered Nurse	RN179544	AZ

General Provider Information

NPI Number	:	1265149520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MONICA RAQUEL BYERS RN

Provider Business Mailing Address
First Line	:	3041 ORO GRANDE BLVD
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-9037
Country	:	US
Telephone Number	:	928-499-4414
Fax Number	:

Provider Business Practice Location Address
First Line	:	3041 ORO GRANDE BLVD
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-9037
Country	:	US
Telephone Number	:	928-499-4414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2022
Last Update Date	:	11/04/2022

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