Healthcare Provider Details

I. General information

NPI: 1306934211
Provider Name (Legal Business Name): PATRICIA WICKHAM-MONSEGUR CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 S DOBSON RD
CHANDLER AZ
85224-5710
US

IV. Provider business mailing address

2435 S PECAN DR
CHANDLER AZ
85286-7407
US

V. Phone/Fax

Practice location:
  • Phone: 480-899-9800
  • Fax: 489-899-2994
Mailing address:
  • Phone: 602-478-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0129
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: