Provider Demographics
NPI:1861457855
Name:MONSON, ERNEST S (NP)
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:S
Last Name:MONSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:SHAYNE
Other - Middle Name:
Other - Last Name:MONSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2331 HUALAPAI MOUNTAIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-6207
Mailing Address - Country:US
Mailing Address - Phone:928-529-5086
Mailing Address - Fax:928-529-5089
Practice Address - Street 1:2331 HUALAPAI MOUNTAIN RD STE A
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-6207
Practice Address - Country:US
Practice Address - Phone:928-529-5086
Practice Address - Fax:928-529-5089
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ 7237111N00000X
AZAP8097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ184704Medicare PIN
AZZ129798Medicare PIN
AZU82078Medicare UPIN