Healthcare Provider Details

I. General information

NPI: 1033350772
Provider Name (Legal Business Name): MYA JANELL MONTOYA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5538 GOLDEN WILLOW DR
FORT COLLINS CO
80528-6395
US

IV. Provider business mailing address

5538 GOLDEN WILLOW DR
FORT COLLINS CO
80528-6395
US

V. Phone/Fax

Practice location:
  • Phone: 404-825-3073
  • Fax: 888-512-2215
Mailing address:
  • Phone: 404-825-3073
  • Fax: 888-512-2215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number082154
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.0996750
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number215077
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: