Healthcare Provider Details

I. General information

NPI: 1326722877
Provider Name (Legal Business Name): HEATHER ANNE MONZON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HEATHER ANNE KELLY

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279B SUMMIT DR
WATERFORD MI
48328-3364
US

IV. Provider business mailing address

279 SUMMIT DR
WATERFORD MI
48328-3364
US

V. Phone/Fax

Practice location:
  • Phone: 248-745-4900
  • Fax: 248-994-8005
Mailing address:
  • Phone: 248-871-1453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number4704297554
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number4704297554
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704297554
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number4704297554
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704297554
License Number StateMI
# 6
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number4704297554
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: