Healthcare Provider Details

I. General information

NPI: 1295001105
Provider Name (Legal Business Name): MARTHA ANICE ANDREA MONSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2012
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD ST # 130
MURRAY UT
84107-5701
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-7400
  • Fax:
Mailing address:
  • Phone: 801-507-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number8809916-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: