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General NPI Number Information
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NPI Number | 1457058646
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Entity Type | Organization
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Legal Business Name | MONOVO LLC
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Dates
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Enumeration Date | 02/08/2023
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 2578 W 600 N STE 201
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City | LINDON
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State | UT
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Zip | 84042-1260
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Country | US
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Telephone | 801-896-9868
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Fax | 801-823-6337
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Provider Business Mailing Address
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Address Line | 2578 W 600 N STE 201
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City | LINDON
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State | UT
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Zip | 84042-1260
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Country | US
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Telephone | 801-896-9868
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL OPERATIONS
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Name | MR. TYSON WADE LEWIS
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Credential | RN
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Telephone | 801-380-4462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | NULL
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State | NULL
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | NULL
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Taxonomy #6
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State | NULL
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Taxonomy #7
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State | NULL
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Taxonomy #8
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State | NULL
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Taxonomy #9
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | NULL
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