MEDICARE: MS. ELIZABETH A. MONSON C.R.N.P.

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
1	363LA2200X	Adult Health Nurse Practitioner	270915-4405	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	622436-01	OTHER	MD	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1912998451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELIZABETH A. MONSON C.R.N.P.

Provider Business Mailing Address
First Line	:	5121 S COTTONWOOD ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-5701
Country	:	US
Telephone Number	:	801-507-4000
Fax Number	:	801-507-4811

Provider Business Practice Location Address
First Line	:	3600 NW SAMARITAN DR
Second Line	:	SUITE E350
City	:	CORVALLIS
State	:	OR
Zip	:	97330-3737
Country	:	US
Telephone Number	:	541-768-5205
Fax Number	:	541-768-6520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	05/29/2019

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