Basic Information
| Provider Information | |||||||||
| NPI: | 1508447913 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MONCIBAEZ | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | LUCILLE | ||||||||
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| Credential: | DNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 928 S 3RD ST | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863266349 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9283013003 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 340 S WILLARD ST | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863264126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286396025 | ||||||||
| FaxNumber: | 9286497936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2021 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 254601 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.