Healthcare Provider Details

I. General information

NPI: 1063988129
Provider Name (Legal Business Name): MONETTE PARRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONETTE PARRY REED RN

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 N WASHINGTON BLVD
OGDEN UT
84414-7233
US

IV. Provider business mailing address

520 W 4050 N
PLEASANT VIEW UT
84414-1028
US

V. Phone/Fax

Practice location:
  • Phone: 801-786-7500
  • Fax:
Mailing address:
  • Phone: 801-510-9799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200754-4005
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: