Provider Demographics
NPI:1306322441
Name:MOUNGA, EMANITA CHRISTABLE (FNP-C)
Entity type:Individual
Prefix:
First Name:EMANITA
Middle Name:CHRISTABLE
Last Name:MOUNGA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13473 S FIREBACK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-4504
Mailing Address - Country:US
Mailing Address - Phone:801-918-9985
Mailing Address - Fax:
Practice Address - Street 1:4133 W. PIONEER PARKWAY
Practice Address - Street 2:STE 100
Practice Address - City:WEST VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84120
Practice Address - Country:US
Practice Address - Phone:801-250-9638
Practice Address - Fax:801-250-3204
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9131166-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily