Provider Demographics
NPI:1326722877
Name:MONZON, HEATHER ANNE (RN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANNE
Last Name:MONZON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANNE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:279 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3364
Mailing Address - Country:US
Mailing Address - Phone:248-871-1453
Mailing Address - Fax:
Practice Address - Street 1:279B SUMMIT DR
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3364
Practice Address - Country:US
Practice Address - Phone:248-745-4900
Practice Address - Fax:248-994-8005
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704297554163WC0400X, 163WC1500X, 163WH0200X, 163WP0000X, 163WP0808X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health