Provider Demographics
NPI:1033350772
Name:MONTOYA, MYA JANELL (CRNA)
Entity Type:Individual
Prefix:
First Name:MYA
Middle Name:JANELL
Last Name:MONTOYA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24503
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-0503
Mailing Address - Country:US
Mailing Address - Phone:425-407-1500
Mailing Address - Fax:888-512-2215
Practice Address - Street 1:12040 NE 128TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3013
Practice Address - Country:US
Practice Address - Phone:425-407-1500
Practice Address - Fax:888-512-2215
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC215077163W00000X
NC082154367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8053694Medicaid
NC8053694Medicaid