Healthcare Provider Details

I. General information

NPI: 1205304573
Provider Name (Legal Business Name): LYNN MARIE MONTEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN MARIE SORENSION RN

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 E OSBORN RD
PHOENIX AZ
85016-7236
US

IV. Provider business mailing address

2002 E OSBORN RD
PHOENIX AZ
85016-7236
US

V. Phone/Fax

Practice location:
  • Phone: 602-730-3388
  • Fax:
Mailing address:
  • Phone: 602-730-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number224984
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN089517
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: