Healthcare Provider Details

I. General information

NPI: 1114657772
Provider Name (Legal Business Name): MONICA L AMOS WILLIAMS APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2022
Last Update Date: 06/15/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 N 19TH AVE STE 111
PHOENIX AZ
85015-3211
US

IV. Provider business mailing address

5060 N 19TH AVE STE 111
PHOENIX AZ
85015-3211
US

V. Phone/Fax

Practice location:
  • Phone: 979-739-1490
  • Fax:
Mailing address:
  • Phone: 979-739-1490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number271476
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number892486
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: