Provider Demographics
NPI:1558778902
Name:MONTES, BOZENA BEATA (AGNP, ACNP)
Entity Type:Individual
Prefix:MRS
First Name:BOZENA
Middle Name:BEATA
Last Name:MONTES
Suffix:
Gender:F
Credentials:AGNP, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15024 S ROSE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-3639
Mailing Address - Country:US
Mailing Address - Phone:773-653-9622
Mailing Address - Fax:
Practice Address - Street 1:3802 S 700 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1182
Practice Address - Country:US
Practice Address - Phone:801-264-6000
Practice Address - Fax:801-564-6098
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11334524-4405363LA2100X, 363LA2200X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology