=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033350772
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MYA JANELL MONTOYA CRNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2009
-----------------------------------------------------
Last Update Date | 03/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5538 GOLDEN WILLOW DR
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80528-6395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-825-3073
-----------------------------------------------------
Fax | 888-512-2215
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5538 GOLDEN WILLOW DR
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80528-6395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-825-3073
-----------------------------------------------------
Fax | 888-512-2215
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | 082154
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367500000X
-----------------------------------------------------
Taxonomy Name | Certified Registered Nurse Anesthetist
-----------------------------------------------------
License Number | APN.0996750
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 215077
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------