Provider Demographics
NPI:1306934211
Name:WICKHAM-MONSEGUR, PATRICIA (CRNA)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WICKHAM-MONSEGUR
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2435 S PECAN DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-7407
Mailing Address - Country:US
Mailing Address - Phone:602-478-9111
Mailing Address - Fax:
Practice Address - Street 1:875 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5710
Practice Address - Country:US
Practice Address - Phone:480-899-9800
Practice Address - Fax:489-899-2994
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0129367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ142132OtherMEDICARE PTAN