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NPI Code Detail

MEDICARE: MRS. BOZENA BEATA MONTES AGNP, ACNP

MEDICARE: MRS. BOZENA BEATA MONTES AGNP, ACNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2100XAcute Care Nurse Practitioner11334524-4405UT
2363LA2200XAdult Health Nurse Practitioner11334524-4405UT
3363LG0600XGerontology Nurse Practitioner11334524-4405UT
4363L00000XNurse Practitioner11334524-4405UT

General Provider Information

NPI Number : 1558778902
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BOZENA BEATA MONTES AGNP, ACNP
Provider Business Mailing Address
First Line : 15024 S ROSE CREEK LN
Second Line :
City : HERRIMAN
State : UT
Zip : 84096-3639
Country : US
Telephone Number : 773-653-9622
Fax Number :
Provider Business Practice Location Address
First Line : 3802 S 700 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84106-1182
Country : US
Telephone Number : 801-264-6000
Fax Number : 801-564-6098
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2014
Last Update Date : 02/07/2023

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