Provider Demographics
NPI:1023209178
Name:BACHTELL, MONICA ANN (NFP)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:ANN
Last Name:BACHTELL
Suffix:
Gender:F
Credentials:NFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 KOMAS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84108
Mailing Address - Country:US
Mailing Address - Phone:801-584-5144
Mailing Address - Fax:801-584-5206
Practice Address - Street 1:565 KOMAS DRIVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84108
Practice Address - Country:US
Practice Address - Phone:801-584-5144
Practice Address - Fax:801-584-5206
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT288898-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily