Healthcare Provider Details

I. General information

NPI: 1710804687
Provider Name (Legal Business Name): KETIA SANON MONDESIR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KETIA SANON SANON

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 E MCDOWELL RD
PHOENIX AZ
85006-2506
US

IV. Provider business mailing address

45202 W RHEA RD
MARICOPA AZ
85139-9148
US

V. Phone/Fax

Practice location:
  • Phone: 857-719-2717
  • Fax: 602-839-7663
Mailing address:
  • Phone: 857-719-2717
  • Fax: 602-839-7663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRNP342195
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: