Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 28534 | AZ |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 28534 | AZ |
NPI | 1346222106 |
---|---|
Provider Name | Dr. Carrie J Monroy |
First Address | Flagstaff, AZ 86005-2305 |
Second Address | Flagstaff, AZ 86001-4855 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2005 |
Last Update Date | 16/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
527830 | AHCCCS (01) | AZ |
G13084 | (02) | AZ |