Healthcare Provider Details

I. General information

NPI: 1194323410
Provider Name (Legal Business Name): NATASHA RADINE MONTOYA MSN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2020
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 CAPITOL AVE STE 415
CHEYENNE WY
82001-4562
US

IV. Provider business mailing address

1603 CAPITOL AVE STE 415
CHEYENNE WY
82001-4562
US

V. Phone/Fax

Practice location:
  • Phone: 702-860-2887
  • Fax:
Mailing address:
  • Phone: 702-860-2887
  • Fax: 520-495-3443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN174257
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number323998
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5013790
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: