Healthcare Provider Details

I. General information

NPI: 1134683071
Provider Name (Legal Business Name): MONICA E. M. ECCLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 E BROADWAY BLVD
TUCSON AZ
85711-3511
US

IV. Provider business mailing address

4601 E BROADWAY BLVD
TUCSON AZ
85711-3511
US

V. Phone/Fax

Practice location:
  • Phone: 520-399-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number220571
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: