Provider Demographics
NPI:1659123891
Name:WHITE, MONIQUE MARIE (PA)
Entity Type:Individual
Prefix:
First Name:MONIQUE
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8520 E LAREDO LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-6757
Mailing Address - Country:US
Mailing Address - Phone:480-399-0680
Mailing Address - Fax:
Practice Address - Street 1:5250 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2747
Practice Address - Country:US
Practice Address - Phone:480-420-1005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant