Healthcare Provider Details

I. General information

NPI: 1154199677
Provider Name (Legal Business Name): MRS. NICHOLE MICHELLE MONRREAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. NICHOLE MICHELLE TRAYLOR

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 W CONGRESS ST
TUCSON AZ
85745-2819
US

IV. Provider business mailing address

839 W CONGRESS ST
TUCSON AZ
85745-2819
US

V. Phone/Fax

Practice location:
  • Phone: 520-670-3909
  • Fax: 520-309-2560
Mailing address:
  • Phone: 520-670-3909
  • Fax: 520-309-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH04988
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: