Healthcare Provider Details

I. General information

NPI: 1639562093
Provider Name (Legal Business Name): MONIQUE FINCANNON PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2015
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 S CAMINO REAL
PALM SPRINGS CA
92264-9290
US

IV. Provider business mailing address

1910 S CAMINO REAL
PALM SPRINGS CA
92264-9290
US

V. Phone/Fax

Practice location:
  • Phone: 760-408-2315
  • Fax:
Mailing address:
  • Phone: 760-408-2315
  • Fax: 760-408-2315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2008005365
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number898960
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2015005077
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP130589
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberNP95013176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: