Healthcare Provider Details

I. General information

NPI: 1437820891
Provider Name (Legal Business Name): MONIKA KOEHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2021
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE STE 203
PHOENIX AZ
85027-4022
US

IV. Provider business mailing address

2910 N 3RD AVE # 200
PHOENIX AZ
85013-4434
US

V. Phone/Fax

Practice location:
  • Phone: 623-562-5050
  • Fax: 623-562-5051
Mailing address:
  • Phone: 602-406-3181
  • Fax: 602-264-2417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA.0007628
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number11385
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: