Provider Demographics
NPI:1407963341
Name:RAUTON, MONICA KENDALL (NP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:KENDALL
Last Name:RAUTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3118
Mailing Address - Country:US
Mailing Address - Phone:928-213-6235
Mailing Address - Fax:928-213-6292
Practice Address - Street 1:1759 E VILLA DR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4681
Practice Address - Country:US
Practice Address - Phone:928-639-5095
Practice Address - Fax:928-226-6410
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN073457163W00000X
AZAP6834363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ511841Medicaid
AZ511841Medicaid
AZS87428Medicare UPIN