MEDICARE: MYA JANELL MONTOYA CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	082154	NC
2	367500000X	Certified Registered Nurse Anesthetist	APN.0996750	CO
3	163W00000X	Registered Nurse	215077	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033350772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYA JANELL MONTOYA CRNA

Provider Business Mailing Address
First Line	:	5538 GOLDEN WILLOW DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-6395
Country	:	US
Telephone Number	:	404-825-3073
Fax Number	:	888-512-2215

Provider Business Practice Location Address
First Line	:	5538 GOLDEN WILLOW DR
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-6395
Country	:	US
Telephone Number	:	404-825-3073
Fax Number	:	888-512-2215

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2009
Last Update Date	:	03/05/2025

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