Healthcare Provider Details

I. General information

NPI: 1689945271
Provider Name (Legal Business Name): VA SHARON MOUNGA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W UNIVERSITY PKWY STUDENT HEALTH SERVICES SC 221
OREM UT
84058-6703
US

IV. Provider business mailing address

1056 W 2300 N
PROVO UT
84604-1228
US

V. Phone/Fax

Practice location:
  • Phone: 801-863-8876
  • Fax:
Mailing address:
  • Phone: 801-995-0682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6470833-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6470833-8900
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: