Healthcare Provider Details

I. General information

NPI: 1720303837
Provider Name (Legal Business Name): NICHOLAS E MONSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2132 N 1700 W 230
LAYTON UT
84041-7057
US

IV. Provider business mailing address

2132 N 1700 W 230
LAYTON UT
84041-7057
US

V. Phone/Fax

Practice location:
  • Phone: 801-773-3900
  • Fax:
Mailing address:
  • Phone: 801-773-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number8134453-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: