Healthcare Provider Details

I. General information

NPI: 1083538268
Provider Name (Legal Business Name): MONARCH DERMATOLOGY AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 W OLIVE AVE STE 102
GLENDALE AZ
85302-3147
US

IV. Provider business mailing address

5700 W OLIVE AVE STE 102
GLENDALE AZ
85302-3147
US

V. Phone/Fax

Practice location:
  • Phone: 623-377-2572
  • Fax:
Mailing address:
  • Phone: 623-377-2572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATHRINA RIDLEY
Title or Position: OWNER/PROVIDER
Credential: FNP-C
Phone: 623-377-2572