Provider Demographics
NPI:1346097367
Name:MONSON, MARY DEANNE (NURSE PRACTIONER)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DEANNE
Last Name:MONSON
Suffix:
Gender:F
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:DEANNE
Other - Last Name:MOAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14308 S CLASSIC CV
Mailing Address - Street 2:
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84065-5440
Mailing Address - Country:US
Mailing Address - Phone:801-592-5667
Mailing Address - Fax:
Practice Address - Street 1:14308 S CLASSIC CV
Practice Address - Street 2:
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-5440
Practice Address - Country:US
Practice Address - Phone:801-592-5667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9260069-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily