Healthcare Provider Details

I. General information

NPI: 1689716888
Provider Name (Legal Business Name): A. SUE MONTIEL CNM-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 03/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 S 1100 E STE 209
SALT LAKE CITY UT
84102-1580
US

IV. Provider business mailing address

24 S 1100 E STE 209
SALT LAKE CITY UT
84102-1580
US

V. Phone/Fax

Practice location:
  • Phone: 801-908-0930
  • Fax: 801-531-0930
Mailing address:
  • Phone: 801-908-0920
  • Fax: 801-531-0930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number213560-4401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: