Healthcare Provider Details

I. General information

NPI: 1386354512
Provider Name (Legal Business Name): SHAUNA LYNN MONTOYA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2022
Last Update Date: 09/06/2023
Certification Date: 09/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 ENCINO PL NE
ALBUQUERQUE NM
87102-2619
US

IV. Provider business mailing address

711 ENCINO PL NE
ALBUQUERQUE NM
87102-2619
US

V. Phone/Fax

Practice location:
  • Phone: 505-224-7400
  • Fax: 505-224-7404
Mailing address:
  • Phone: 505-224-7400
  • Fax: 505-224-7404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number70833
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: