Provider Demographics
NPI:1508447913
Name:MONCIBAEZ, JULIE LUCILLE (DNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:LUCILLE
Last Name:MONCIBAEZ
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-6349
Mailing Address - Country:US
Mailing Address - Phone:928-301-3003
Mailing Address - Fax:
Practice Address - Street 1:340 S WILLARD ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4126
Practice Address - Country:US
Practice Address - Phone:928-639-6025
Practice Address - Fax:928-649-7936
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ254601363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily